Although it is anticipated that most patients with renal insufficiency will
progress towards end-stage renal disease (ESRD) there have been few popula
tion-based studies to validate this assumption. We examined serial creatini
nes from 3,874 anonymous patients at an urban VA medical center who had a b
aseline creatinine of 1.4 mg/dl or greater to estimate the frequency of det
erioration in renal function (DRF). DRF was defined as the first Cr (1stCr)
value being lower than the last Cr (LCr) for each patient. The median foll
ow-up was 48.3 +/- 0.5 months with 18 +/- 0.5 creatinine values per patient
. The median 1stCr was 1.6 +/- 0.1 mg/dl with 32.2% of the patients having
a 1stCr greater than or equal to 1.7 mg/dl. In the study group, 1,723 (44.4
%) had DRF including 1,089 (41.4%) of those patients with a 1stCr of 1.4-1.
7 mg/dl. However, 45 (36.6%) of those with a 1stCr value 3.0-5.0 mg/dl did
not have DRF, the percent with stable creatinine in this group did not vary
with length of follow-up. Over the study period, 299 (7.7%) of all the pat
ients had a creatinine rise to 7.0 mg/dl, with 104 (4%) of those with a 1st
Cr of 1.4-1.7 mg/dl reaching this endpoint. Conclusion: A majority, but not
all, patients with renal insufficiency lose renal function overtime and th
ose with even mild hypercreatinemia are at risk for deterioration in renal
function. Hypercreatinemia, however, does not accurately discriminate betwe
en those renal insufficiency patients who are stable versus those at high r
isk for ESRD. Copyright (C) 2001 S. Karger AG, Basel.