Significance of serum creatinine values in new end-stage renal disease patients

The appropriate use of serum creatinine level as a surrogate for time in th e course of renal failure when dialysis commences requires it to be a signi ficant predictor of mortality in incident patients with end-stage renal dis ease (ESRD), This study evaluated factors that account for variations in cr eatinine level before the initiation of dialysis and whether incident creat inine level after controlling for these factors was a risk factor for morta lity. This is a retrospective cohort study of patients from Maryland and Vi rginia who initiated dialysis between April 1, 1995, and December 31, 1996, with data ascertained from the Health Care Financing Administration Form 2 728, Multivariate models were used to evaluate both the factors that predic t incident serum creatinine level and the association between creatinine le vel and mortality. There were 5,388 patients followed up for an average of 23.6 +/- 0.2 months. Mean creatinine level was 9.2 +/- 0.1 mg/dL, with case -mix factors most predictive of serum creatinine level and accounting for 9 % of its variance, Hematocrit and blood urea nitrogen levels as additional surrogates far progression of renal disease accounted for 7.4% of the varia nce, whereas the nutritional parameters, body mass index, and albumin level only explained an additional 1% of the total variance in creatinine level. Creatinine level was inversely correlated with mortality risk, and this re lationship was sustained both with transformation into an estimated glomeru lar filtration rate and multivariate adjustment for confounders (relative r isk = 0.96; P < 0.0001), Creatinine values from an incident ESRD population have a weak relationship with the timing of dialysis initiation but repres ent a strong measure of health status. (C) 1999 by the National Kidney Foun dation, Inc.