Mengjing Wang1,2, Yoshitsugu Obi1, Elani Streja1,3, Connie M Rhee1,3, Jing Chen2, Chuanming Hao2, Csaba P Kovesdy4,5, Kamyar Kalantar-Zadeh1,3,6. 1. Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of Nephrology and Hypertension, Department of Medicine, University of California Irvine Medical Center, Orange, CA, USA. 2. Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan University, Shanghai, China. 3. Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, USA. 4. Division of Nephrology, Department of Medicine, University of Tennessee Health Science Center, Memphis, TN, USA. 5. Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA. 6. Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
Abstract
Background: Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods: Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007-11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results: The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74-4.85] mL/min/1.73 m2 and 1.32 ± 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5-2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e. <3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (≥1.2) spKt/V were 1.40 (1.12-1.74), 1.21 (1.10-1.33), 1.06 (0.98-1.14), and 1.00 (0.93-1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions: Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.
Background: Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods: Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007-11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results: The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74-4.85] mL/min/1.73 m2 and 1.32 ± 0.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5-2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction = 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e. <3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (≥1.2) spKt/V were 1.40 (1.12-1.74), 1.21 (1.10-1.33), 1.06 (0.98-1.14), and 1.00 (0.93-1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions: Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.
Authors: Tobias Kurth; Alexander M Walker; Robert J Glynn; K Arnold Chan; J Michael Gaziano; Klaus Berger; James M Robins Journal: Am J Epidemiol Date: 2005-12-21 Impact factor: 4.897
Authors: Yoshitsugu Obi; Connie M Rhee; Anna T Mathew; Gaurang Shah; Elani Streja; Steven M Brunelli; Csaba P Kovesdy; Rajnish Mehrotra; Kamyar Kalantar-Zadeh Journal: J Am Soc Nephrol Date: 2016-05-11 Impact factor: 10.121
Authors: Paungpaga Lertdumrongluk; Elani Streja; Connie M Rhee; Jongha Park; Onyebuchi A Arah; Steven M Brunelli; Allen R Nissenson; Daniel Gillen; Kamyar Kalantar-Zadeh Journal: Am J Nephrol Date: 2014-04-26 Impact factor: 3.754
Authors: Garabed Eknoyan; Gerald J Beck; Alfred K Cheung; John T Daugirdas; Tom Greene; John W Kusek; Michael Allon; James Bailey; James A Delmez; Thomas A Depner; Johanna T Dwyer; Andrew S Levey; Nathan W Levin; Edgar Milford; Daniel B Ornt; Michael V Rocco; Gerald Schulman; Steve J Schwab; Brendan P Teehan; Robert Toto Journal: N Engl J Med Date: 2002-12-19 Impact factor: 91.245