SP353A MAYO CLINIC ROCHESTER THIRTEEN-YEAR RETROSPECTIVE INVESTIGATION OF THE SYNDROME OF RAPID ONSET END STAGE RENAL DISEASE (SORO-ESRD) IN AN INCIDENT ADULT HEMODIALYSIS COHORT, 2001–2013

Abstract

Introduction and Aims: In 2010, we described the new syndrome of rapid onset end stage renal disease or SORO-ESRD. This is acute yet irreversible renal failure in patients with a priori stable CKD. We report the features of SORO-ESRD in a large hemodialysis cohort managed within the Mayo Clinic Health System (MCHS). Methods: We completed a retrospective analysis of all adult (age ≥ 18 years) incident hemodialysis patients seen within the MCHS between January 1, 2001 and December 31, 2013, with Minnesota Research Authorization to identify patients with the syndrome of rapid onset end stage renal disease (SORO-ESRD). The diagnosis of SORO-ESRD rested on two diagnostic criteria - eGFR of ≥ 30 ml/min/1.73 sq. m BSA OR a serum creatinine equivalent of ≤ 1.75 mg/dL in the last year before first hemodialysis and remaining on maintenance RRT for ≥ 90 days without renal recovery. Results: Of 1461 patients analyzed, 149 (10%) patients had SORO-ESRD - 76 males, 73 females, age range 19-95 years, mean age 62 years, with the 70-80 age group being the modal group. Ten of 149 (7%) SORO-ESRD patients were renal allograft recipients. Fifteen of 149 (10%) recovered renal function. Duration on hemodialysis ranged from 90-4166 days, mean 682 days. Vascular access at first hemodialysis was 86 (58%) temporary catheters, 61 (41%) tunneled catheters, 1 (1%) had an AVF. Initial first hemodialysis was in-hospital in 126 (85%) versus outpatient center in 23 (15%) patients. Causes of precipitating AKI was nephritides in 19 of 94 (20%), infection/sepsis in 18 (19%), nephrotoxic medications in 12 (13%), and post-operative in 12 (13%). Twenty-three (15%) patients were transplanted. Ninety-two (62%) had no prior nephrologist evaluation in the last year before hemodialysis. Of the 84 who died, cardiac arrest was the cause in 28 (33%), 22 (26%) died after stopping hemodialysis, and sepsis was the cause of death in 6 (7%) (Figure 1). Conclusions: The syndrome of rapid onset ESRD or SORO-ESRD, which represents acute precipitate yet irreversible ESRD in a priori stable CKD patients following acute kidney injury (AKI), is not a rare occurrence among incident adult ESRD patients on maintenance hemodialysis within the Mayo Clinic Health System affecting 10% of the incident hemodialysis population. As observed previously, the older CKD patient is more susceptible to this phenomenon, with the 71-80 age group in this study being the modal group. SORO-ESRD contributes significantly to renal allograft loss. The causes of death in SORO-ESRD are similar to the general ESRD population. Initial hemodialysis vascular access, as previously reported, is more often temporary hemodialysis catheters and tunneled hemodialysis catheters. Renal recovery occurred in 10% of the SORO-ESRD cohort in this study, a previously observed trend. Only 1 (1%) patient in our study had an AVF for the first hemodialysis treatment. More multi-center studies on the impact of the phenomenon of SORO-ESRD on AVF planning, CKD care in general and on renal transplantation are warranted. (Figure presented).