Clinical EpidemiologyTrends in the Timing and Clinical Context of Maintenance Dialysis InitiationO’Hare, Ann M.*,†,‡; Wong, Susan P.*,†; Yu, Margaret K.*,†; Wynar, Bruce*; Perkins, Mark*; Liu, Chuan-Fen*,§; Lemon, Jaclyn M.*; Hebert, Paul L.*,§ Author Information *Department of Veterans Affairs Health Services Research and Development Center of Excellence, Department of Veterans Affairs Puget Sound Healthcare System, Seattle, Washington; Departments of †Medicine and §Health Services, University of Washington, Seattle, Washington; and ‡Group Health Research Institute, Seattle, Washington Correspondence: Dr. Ann M. O’Hare, 1160 South Columbian Way, Seattle, WA 98119. Email: [email protected] Received May 24, 2013 Accepted September 23, 2014 Journal of the American Society of Nephrology 26(8):p 1975-1981, August 2015. | DOI: 10.1681/ASN.2013050531 Buy Metrics Abstract Whether secular trends in eGFR at dialysis initiation reflect changes in clinical presentation over time is unknown. We reviewed the medical records of a random sample of patients who initiated maintenance dialysis in the Department of Veterans Affairs (VA) in fiscal years 2000–2009 (n=1691) to characterize trends in clinical presentation in relation to eGFR at initiation. Between fiscal years 2000–2004 and 2005–2009, mean eGFR at initiation increased from 9.8±5.8 to 11.0±5.5 ml/min per 1.73 m2 (P<0.001), the percentage of patients with an eGFR of 10–15 ml/min per 1.73 m2 increased from 23.4% to 29.9% (P=0.002), and the percentage of patients with an eGFR>15 ml/min per 1.73 m2 increased from 12.1% to 16.3% (P=0.01). The proportion of patients who were acutely ill at the time of initiation and the proportion of patients for whom the decision to initiate dialysis was based only on level of kidney function did not change over time. Frequencies of documented clinical signs and/or symptoms were similar during both time periods. The adjusted odds of initiating dialysis at an eGFR of 10–15 or >15 ml/min per 1.73 m2 (versus <10 ml/min per 1.73 m2) during the later versus earlier time period were 1.43 (95% confidence interval [95% CI], 1.13 to 1.81) and 1.46 (95% CI, 1.09 to 1.97), respectively. In conclusion, trends in eGFR at dialysis initiation at VA medical centers do not seem to reflect changes in the clinical context in which dialysis is initiated. Copyright © 2015 The Authors. Published by Wolters Kluwer Health, Inc. All rights reserved.