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Decline of kidney function during the pre-dialysis period in chronic kidney disease patients: a systematic review and meta-analysis

Authors Janmaat CJ, van Diepen M, van Hagen CCE, Rotmans JI, Dekker FW, Dekkers OM

Received 6 October 2017

Accepted for publication 31 January 2018

Published 25 May 2018 Volume 2018:10 Pages 613—622


Checked for plagiarism Yes

Review by Single anonymous peer review

Peer reviewer comments 4

Editor who approved publication: Professor Irene Petersen

Cynthia J Janmaat,1 Merel van Diepen,1 Cheyenne CE van Hagen,1 Joris I Rotmans,2 Friedo W Dekker,1 Olaf M Dekkers1,2

1Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands, 2Department of Internal Medicine, Leiden University Medical Center, Leiden, the Netherlands

Purpose: Substantial heterogeneity exists in reported kidney function decline in pre-dialysis chronic kidney disease (CKD). By design, kidney function decline can be studied in CKD 3–5 cohorts or dialysis-based studies. In the latter, patients are selected based on the fact that they initiated dialysis, possibly leading to an overestimation of the true underlying kidney function decline in the pre-dialysis period. We performed a systematic review and meta-analysis to compare the kidney function decline during pre-dialysis in CKD stage 3–5 patients, in these two different study types.
Patients and methods: We searched PubMed, EMBASE, Web of Science and Cochrane to identify eligible studies reporting an estimated glomerular filtration rate (eGFR) decline (mL/min/1.73 m2) in adult pre-dialysis CKD patients. Random-effects meta-analysis was performed to obtain weighted mean annual eGFR decline.
Results: We included 60 studies (43 CKD 3–5 cohorts and 17 dialysis-based studies). The meta-analysis yielded a weighted annual mean (95% CI) eGFR decline during pre-dialysis of 2.4 (95% CI: 2.2, 2.6) mL/min/1.73 m2 in CKD 3–5 cohorts compared to 8.5 (95% CI: 6.8, 10.1) in dialysis-based studies (difference 6.0 [95% CI: 4.8, 7.2]).
Conclusion: To conclude, dialysis-based studies report faster mean annual eGFR decline during pre-dialysis than CKD 3–5 cohorts. Thus, eGFR decline data from CKD 3–5 cohorts should be used to guide clinical decision making in CKD patients and for power calculations in randomized controlled trials with CKD progression during pre-dialysis as the outcome.

Keywords: meta-analysis, systematic review, kidney function decline, dialysis, chronic kidney disease, pre-dialysis, CKD progression

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