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The number of patients with end-stage renal disease is increasing globally. Despite that, we still have few population-based studies involving patients with CKD on pre-dialysis. With the advent of SGLT2i, a new outlook on clinical outcomes has become possible.
This prospective study consisted of a cohort of patients with CKD referred to pre-dialysis care provided by the Sistema Unico de Saude (SUS). During follow-up, all patients were actively informed about the need for planned vascular access, immunization for hepatitis B, and the modalities of Renal Replacement Therapy (RRT). Counseling for optimal blood pressure (<140x90mmHg) and glycemic control (HgA1c<7%) was provided. Patients with a higher risk for progression to RRT were selected with the use of the “Kidney failure risk equations” (KFREs). Continuous variables were expressed as mean and standard deviation. Cox proportional regression model and Log-Rank test were used to adjust survival curves (software STATA 13.1, Stata Corp, USA). The privacy of subjects and the confidentiality of their personal information were handled following the ethical principles of the Declaration of Helsinki.
From April 2016 to Oct 2023, 607 patients (63.5 ± 0.7 years of age; 55.2% male) received predialysis care. A total of 3,050 outpatient visits involving patients with CKD stage IV and V were assessed. 48 patients returned to primary care due to the low risk of progression (<10% KFREs) and 24 were referred to general nephrology care. Four patients opted for palliative care. 106 initiated dialysis. DM was the most prevalent isolated cause of CKD (27.8%). Immunization for HBV was successful in 20.9% of patients with CKD stage IV and V. 23.7% of patients with CKD stage V had a working AV fistula and 12.6% opted for peritoneal dialysis. Patients not in the use of SGLT2i had a shorter time to initiation of RRT compared to users (median 77.7 months versus not achieved).
Despite the increasing number of patients with CKD worldwide, providing a comprehensive and well-designed plan of care for patients on pre-dialysis remains a challenge. Studying this population can help us align the risk for progression with the local availability of healthcare resources while personalizing the care of patients with CKD. In our cohort of patients on predialysis care, SGLT2i use resulted in a longer kidney survival compared to non-users.