Matthew B Rivara1, Chang Huei Chen2, Anupama Nair2, Denise Cobb3, Jonathan Himmelfarb4, Rajnish Mehrotra4. 1. Kidney Research Institute, Seattle, WA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA. Electronic address: mbr@uw.edu. 2. Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA. 3. Northwest Kidney Centers, Seattle, WA. 4. Kidney Research Institute, Seattle, WA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
Abstract
BACKGROUND: Initiation of maintenance dialysis therapy for patients with chronic kidney failure is a period of high risk for adverse patient outcomes. Whether indications for dialysis therapy initiation are associated with mortality in this population is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 461 patients who initiated dialysis therapy (hemodialysis, 437; peritoneal dialysis, 24) from January 1, 2004, through December 31, 2012, and were treated in facilities operated by a single dialysis organization. Follow-up for the primary outcome was through December 31, 2013. PREDICTOR: Clinically documented primary indication for dialysis therapy initiation, as categorized into 4 groups: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload or hypertension, and other/unknown. OUTCOMES: All-cause mortality. RESULTS: During a median follow-up of 2.4 years, 183 (40%) patients died. Crude mortality rates were 10.0 (95% CI, 6.8-14.7), 12.7 (95% CI, 10.2-15.7), 21.7 (95% CI, 16.4-28.6), and 12.2 (95% CI, 6.8-14.7) deaths/100 patient-years among patients initiating dialysis therapy primarily for laboratory evidence of kidney function decline, uremic symptoms, volume overload or hypertension, and other/unknown reason, respectively. Following adjustment for demographic variables, coexisting illnesses, and estimated glomerular filtration rate, initiation of dialysis therapy for uremic symptoms, volume overload or hypertension, or other/unknown reasons was associated with 1.12 (95% CI, 0.72-1.77), 1.69 (95% CI, 1.02-2.80), and 1.28 (95% CI, 0.73-2.26) times higher risk, respectively, for subsequent mortality compared to initiation for laboratory evidence of kidney function decline. LIMITATIONS: Possibility of residual confounding by unmeasured variables; reliance on clinical documentation to ascertain exposure. CONCLUSIONS: Patients initiating dialysis therapy due to volume overload may have increased risk for mortality compared with patients initiating dialysis due to laboratory evidence of kidney function decline. Further studies are needed to identify and test interventions that might reduce this risk.
BACKGROUND: Initiation of maintenance dialysis therapy for patients with chronic kidney failure is a period of high risk for adverse patient outcomes. Whether indications for dialysis therapy initiation are associated with mortality in this population is unknown. STUDY DESIGN: Retrospective cohort study. SETTING & PARTICIPANTS: 461 patients who initiated dialysis therapy (hemodialysis, 437; peritoneal dialysis, 24) from January 1, 2004, through December 31, 2012, and were treated in facilities operated by a single dialysis organization. Follow-up for the primary outcome was through December 31, 2013. PREDICTOR: Clinically documented primary indication for dialysis therapy initiation, as categorized into 4 groups: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload or hypertension, and other/unknown. OUTCOMES: All-cause mortality. RESULTS: During a median follow-up of 2.4 years, 183 (40%) patients died. Crude mortality rates were 10.0 (95% CI, 6.8-14.7), 12.7 (95% CI, 10.2-15.7), 21.7 (95% CI, 16.4-28.6), and 12.2 (95% CI, 6.8-14.7) deaths/100 patient-years among patients initiating dialysis therapy primarily for laboratory evidence of kidney function decline, uremic symptoms, volume overload or hypertension, and other/unknown reason, respectively. Following adjustment for demographic variables, coexisting illnesses, and estimated glomerular filtration rate, initiation of dialysis therapy for uremic symptoms, volume overload or hypertension, or other/unknown reasons was associated with 1.12 (95% CI, 0.72-1.77), 1.69 (95% CI, 1.02-2.80), and 1.28 (95% CI, 0.73-2.26) times higher risk, respectively, for subsequent mortality compared to initiation for laboratory evidence of kidney function decline. LIMITATIONS: Possibility of residual confounding by unmeasured variables; reliance on clinical documentation to ascertain exposure. CONCLUSIONS:Patients initiating dialysis therapy due to volume overload may have increased risk for mortality compared with patients initiating dialysis due to laboratory evidence of kidney function decline. Further studies are needed to identify and test interventions that might reduce this risk.
Authors: Elsayed Z Soliman; Ronald J Prineas; Alan S Go; Dawei Xie; James P Lash; Mahboob Rahman; Akinlolu Ojo; Val L Teal; Nancy G Jensvold; Nancy L Robinson; Daniel L Dries; Lydia Bazzano; Emile R Mohler; Jackson T Wright; Harold I Feldman Journal: Am Heart J Date: 2010-06 Impact factor: 4.749
Authors: Nisha Bansal; Ronit Katz; Lorien Dalrymple; Ian de Boer; Christopher DeFilippi; Bryan Kestenbaum; Meyeon Park; Mark Sarnak; Stephen Seliger; Michael Shlipak Journal: Clin J Am Soc Nephrol Date: 2015-01-20 Impact factor: 8.237
Authors: Kamyar Kalantar-Zadeh; Deborah L Regidor; Csaba P Kovesdy; David Van Wyck; Suphamai Bunnapradist; Tamara B Horwich; Gregg C Fonarow Journal: Circulation Date: 2009-01-26 Impact factor: 29.690
Authors: Nisha Bansal; Charles E McCulloch; Mahboob Rahman; John W Kusek; Amanda H Anderson; Dawei Xie; Raymond R Townsend; Claudia M Lora; Jackson Wright; Alan S Go; Akinlolu Ojo; Arnold Alper; Eva Lustigova; Magda Cuevas; Radhakrishna Kallem; Chi-Yuan Hsu Journal: Hypertension Date: 2014-10-06 Impact factor: 10.190
Authors: Andrew S Levey; Lesley A Stevens; Christopher H Schmid; Yaping Lucy Zhang; Alejandro F Castro; Harold I Feldman; John W Kusek; Paul Eggers; Frederick Van Lente; Tom Greene; Josef Coresh Journal: Ann Intern Med Date: 2009-05-05 Impact factor: 25.391
Authors: Nisha Bansal; Jason Roy; Hsiang-Yu Chen; Rajat Deo; Mirela Dobre; Michael J Fischer; Elyse Foster; Alan S Go; Jiang He; Martin G Keane; John W Kusek; Emile Mohler; Sankar D Navaneethan; Mahboob Rahman; Chi-Yuan Hsu Journal: Am J Kidney Dis Date: 2018-05-18 Impact factor: 8.860
Authors: Kai-Uwe Eckardt; Nisha Bansal; Josef Coresh; Marie Evans; Morgan E Grams; Charles A Herzog; Matthew T James; Hiddo J L Heerspink; Carol A Pollock; Paul E Stevens; Manjula Kurella Tamura; Marcello A Tonelli; David C Wheeler; Wolfgang C Winkelmayer; Michael Cheung; Brenda R Hemmelgarn Journal: Kidney Int Date: 2018-04-12 Impact factor: 10.612
Authors: Benjamin J Lee; Chi-Yuan Hsu; Rishi V Parikh; Thomas K Leong; Thida C Tan; Sophia Walia; Kathleen D Liu; Raymond K Hsu; Alan S Go Journal: BMC Nephrol Date: 2018-06-11 Impact factor: 2.388