Abstract
Background:
The prevalence and incidence of CKD have been increasing in Thailand caused by the
pandemic of non-communicable disease or the inappropriateness of renal replacement therapy
initiation. The optimum or critical renal function for renal replacement therapy initiation has been
an important issue. Late renal replacement therapy may cause morbidity and mortality while too
early renal replacement therapy cause patients’ morbidity and unnecessary health economic
burden. This study aimed to investigate the association of renal function at renal replacement
therapy initiation towards clinical outcome and investigate the comparison of mode of renal
replacement therapy towards patients’ outcome.
Methods:
The evaluation of pre-renal replacement therapy renal function was investigated by cross
sectional study. The results of most accurate pre-renal replacement therapy renal function
assessment was used to enroll patients in multicenter, prospective observational study for
association of renal function, mode of renal replacement therapy and clinical outcome
Results.
113 cases of CKD stage V by CKD-EPI equation who expected for renal replacement therapy
were enrolled for the cross sectional study. The average age was 59.2 ± 17.8 years and
average serum creatinine was 6.59 ± 3.00 mg/dL. By reference 99Tc-DTPA plasma isotope
renal clearance GFR study, the average renal function was 16.6 ± 5.5 mL/min per 1.73 m2.
CKD-EPI Equation for GFR severely underestimated pre-renal replacement therapy renal
function. Cystatin C based GFR showed better performance and Thai GFR Equation showed
best estimation of late CKD patients who may need renal replacement therapy. 386 late CKD patients who enrolled for renal replacement therapy were included in multicenter,
prospective observational study. The average age of patients was 59.8 ± 16.1 years and
average serum creatinine was 10.81 ± 6.73 mg/dL. The prevalence of co-morbidities was high
and more than 85 % of patients reimbursed the renal replacement therapy cost from the
government reimbursement plan. The renal function when the renal replacement therapy
initiation by CKD-EPI was inaccurate and range from CKD stage IV to early stage V and late V.
The findings cause problems to analyze for the association of renal function, mode of dialysis
and clinical outcome. Thus more cases are needed to be enrolled and more follow up are
needed.
Conclusion:
Renal replacement therapy initiation by CKD-EPI was inaccurate and underestimated renal
function. Renal replacement therapy initiation cases enrollment by CKD-EPI was inappropriate
and cause unnecessary renal replacement therapy reimbursement. Thai GFR equation should
be used for renal replacement therapy initiation. By Thai GFR equation, the investigation for
the association of renal function and mode of dialysis towards clinical outcome can be feasible.
