Arsh K Jain1, Jessica M Sontrop2, Jeffery Perl3, Peter G Blake4, William F Clark4, Louise M Moist5. 1. Division of Nephrology, Department of Medicine, Western University, London, ON, Canada. Electronic address: arsh.jain@lhsc.on.ca. 2. Department of Epidemiology and Biostatistics, Western University, London, ON, Canada. 3. Department of Medicine, Division of Nephrology, University of Toronto, Toronto, ON, Canada. 4. Division of Nephrology, Department of Medicine, Western University, London, ON, Canada. 5. Division of Nephrology, Department of Medicine, Western University, London, ON, Canada; Department of Epidemiology and Biostatistics, Western University, London, ON, Canada.
Abstract
BACKGROUND: Several observational studies of hemodialysis patients show an association between early dialysis therapy initiation and increased mortality. Few studies have examined this association among peritoneal dialysis patients. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A cohort of 8,047 incident peritoneal dialysis patients who started dialysis therapy in 2001-2009 and were treated in Canada. PREDICTOR: Estimated glomerular filtration rate (eGFR) at dialysis therapy initiation. Defined early, mid, and late starts as eGFR>10.5, 7.5-10.5, and <7.5mL/min/1.73m(2), respectively. OUTCOMES: Time to death. MEASUREMENTS: Proportional piecewise exponential survival models to compare mortality (overall and early) for the 3 predictor groups. RESULTS: Between 2001 and 2009, the proportion of patients starting peritoneal dialysis therapy as early starts increased from 29% (95% CI, 26%-32%) to 44% (95% CI, 41%-47%). Compared with the late-start group, the overall mortality rate was not higher for the early- (adjusted HR, 1.08; 95% CI, 0.96-1.23) or mid-start (adjusted HR, 0.96; 95% CI, 0.86-1.09) groups. However, when examined yearly, patients in the early-start group were significantly more likely to die within the first year of dialysis therapy compared with those in the late-start group (adjusted HR, 1.38; 95% CI, 1.10-1.73), but not in subsequent years. LIMITATIONS: Bias and residual confounding may have influenced the observed relationship between predictor and outcome. CONCLUSIONS: Patients are initiating peritoneal dialysis therapy at increasingly higher eGFRs. Contrary to most observational studies assessing hemodialysis, the early initiation of peritoneal dialysis therapy, at eGFR>10.5mL/min/1.73m(2), is not associated with increased mortality.
BACKGROUND: Several observational studies of hemodialysis patients show an association between early dialysis therapy initiation and increased mortality. Few studies have examined this association among peritoneal dialysis patients. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: A cohort of 8,047 incident peritoneal dialysis patients who started dialysis therapy in 2001-2009 and were treated in Canada. PREDICTOR: Estimated glomerular filtration rate (eGFR) at dialysis therapy initiation. Defined early, mid, and late starts as eGFR>10.5, 7.5-10.5, and <7.5mL/min/1.73m(2), respectively. OUTCOMES: Time to death. MEASUREMENTS: Proportional piecewise exponential survival models to compare mortality (overall and early) for the 3 predictor groups. RESULTS: Between 2001 and 2009, the proportion of patients starting peritoneal dialysis therapy as early starts increased from 29% (95% CI, 26%-32%) to 44% (95% CI, 41%-47%). Compared with the late-start group, the overall mortality rate was not higher for the early- (adjusted HR, 1.08; 95% CI, 0.96-1.23) or mid-start (adjusted HR, 0.96; 95% CI, 0.86-1.09) groups. However, when examined yearly, patients in the early-start group were significantly more likely to die within the first year of dialysis therapy compared with those in the late-start group (adjusted HR, 1.38; 95% CI, 1.10-1.73), but not in subsequent years. LIMITATIONS: Bias and residual confounding may have influenced the observed relationship between predictor and outcome. CONCLUSIONS:Patients are initiating peritoneal dialysis therapy at increasingly higher eGFRs. Contrary to most observational studies assessing hemodialysis, the early initiation of peritoneal dialysis therapy, at eGFR>10.5mL/min/1.73m(2), is not associated with increased mortality.
Authors: Erica Winnicki; Kirsten L Johansen; Michael D Cabana; Bradley A Warady; Charles E McCulloch; Barbara Grimes; Elaine Ku Journal: J Am Soc Nephrol Date: 2019-07-18 Impact factor: 10.121
Authors: Louise M Moist; Stanley Fenton; Joseph S Kim; John S Gill; Frank Ivis; Eric de Sa; Juliana Wu; Ahmed A Al-Jaishi; Manish M Sood; Scott Klarenbach; Brenda R Hemmelgarn; Joanne E Kappel Journal: Can J Kidney Health Dis Date: 2014-10-11
Authors: Edouard L Fu; Marie Evans; Juan-Jesus Carrero; Hein Putter; Catherine M Clase; Fergus J Caskey; Maciej Szymczak; Claudia Torino; Nicholas C Chesnaye; Kitty J Jager; Christoph Wanner; Friedo W Dekker; Merel van Diepen Journal: BMJ Date: 2021-11-29