Level of renal function at the initiation of dialysis in the US end-stage renal disease population

Background. More than 285,000 individuals in the United States suffer from end-stage renal disease (ESRD) and are treated predominantly by dialysis. D espite the high cost and poor outcomes of dialysis treatment for ESRD, ther e are few data about the level of renal function at the onset of ESRD and n o established medical criteria for the initiation of dialysis. Methods. We report the level of serum creatinine and glomerular filtration rate (GFR) in 90,897 patients who began dialysis in the U.S. between April 1995 through September 1997. Data were obtained from the U.S. Renal Data Sy stem. GFR was predicted by an equation developed from the Modification of D iet in Renal Disease Study. Results. The mean (SD) serum creatinine was 8.5 (3.8) mg/dl. The mean (SD) predicted GFR was 7.1 (3.1) ml/min/1.73 m(2), with a range from 1 to 42 ml/ min/1.73 m(2). The proportion of patients with predicted GFR of >10, 5 to 1 0, and <5 ml/min/ 1.73 m(2) was 14, 63, and 23%, respectively. The mean pre dicted GFR was significantly lower among younger patients, women, African A mericans, patients with a higher body weight, patients with ESRD because of diseases other than diabetes, uninsured patients, patients who were employ ed, homemakers or students, and patients selecting hemodialysis. Conclusions. There is wide variation in renal function at the initiation of dialysis in the U.S. ESRD population, and a substantial fraction of patien ts start dialysis at very low levels of predicted GFR. Further analyses are needed to examine the factors associated with late initiation of dialysis and its impact on the cost and outcomes of ESRD.