Javier Varas1, María José Pérez-Sáez2, Rosa Ramos1, Jose Ignacio Merello1, Angel Luis M de Francisco3, José Luño4,5, Manuel Praga5,6, Pedro Aljama5,7,8, Julio Pascual2,5. 1. Medical Direction, Fresenius Medical Care, Madrid, Spain. 2. Department of Nephrology, Hospital del Mar, Barcelona, Spain. 3. Department of Nephrology, H. U. Valdecilla, Santander, Spain. 4. Department of Nephrology, Hospital General Universitario Gregorio Marañón, Madrid, Spain. 5. RedInRen, Instituto de Salud Carlos III, Córdoba, Spain. 6. Department of Nephrology, Hospital Universitario Reina Sofía, Córdoba, Spain. 7. Instituto Maimónides de Investigación Biomédica de Córdoba (IMIBIC), Universidad de Córdoba, Córdoba, Spain. 8. Department of Nephrology, Hospital Universitario 12 de Octubre, Madrid, Spain.
Abstract
BACKGROUND: Patients who return to dialysis after kidney allograft failure (KAF) are classically considered to have lower survival rates than their transplant-naïve incident dialysis counterparts. However, this observation in previous comparisons could be due to poor matching between the two populations. METHODS: To compare survival rates between patients who returned to haemodialysis (HD) after KAF versus transplant-naïve incident HD patients, we performed a retrospective study using the EuCliD® database (European Clinical Database) that collects data from Fresenius Medical Care (FMC) outpatient HD facilities in Spain. Propensity score matching (PSM) was performed to homogenize both populations. RESULTS: This study included 5216 patients from 65 different FMC clinics between 2009 and 2014. Naïve incident HD patients were mostly male, older, comorbid and more commonly had catheters as vascular access. During the study follow-up, 3915 patients exited, of whom 1534 died. The mean survival time for the entire cohort was 4.86 years [95% confidence interval (CI) 4.78-4.94]. Univariate Cox analysis indicated higher mortality risk among transplant-naïve incident HD patients [hazard ratio (HR) 1.728; 95% CI 1.35-2.21; P < 0.001). However, this difference was no longer significant after multivariate adjustment. After applying PSM to minimize the bias due to indication issue, we obtained an adjusted population composed of 480 naïve and 240 KAF patients. The results analysing the PSM-adjusted cohort confirmed similar survival in both cohorts (log-rank, 3.34; P = 0.068; HR 1.382; 95% CI 0.97-1.95; P = 0.069). CONCLUSIONS: When comparing properly matched patient groups, patients who return to HD after KAF present similar survival than survival than transplant-naïve incident patients.
BACKGROUND:Patients who return to dialysis after kidney allograft failure (KAF) are classically considered to have lower survival rates than their transplant-naïve incident dialysis counterparts. However, this observation in previous comparisons could be due to poor matching between the two populations. METHODS: To compare survival rates between patients who returned to haemodialysis (HD) after KAF versus transplant-naïve incident HDpatients, we performed a retrospective study using the EuCliD® database (European Clinical Database) that collects data from Fresenius Medical Care (FMC) outpatientHD facilities in Spain. Propensity score matching (PSM) was performed to homogenize both populations. RESULTS: This study included 5216 patients from 65 different FMC clinics between 2009 and 2014. Naïve incident HDpatients were mostly male, older, comorbid and more commonly had catheters as vascular access. During the study follow-up, 3915 patients exited, of whom 1534 died. The mean survival time for the entire cohort was 4.86 years [95% confidence interval (CI) 4.78-4.94]. Univariate Cox analysis indicated higher mortality risk among transplant-naïve incident HDpatients [hazard ratio (HR) 1.728; 95% CI 1.35-2.21; P < 0.001). However, this difference was no longer significant after multivariate adjustment. After applying PSM to minimize the bias due to indication issue, we obtained an adjusted population composed of 480 naïve and 240 KAF patients. The results analysing the PSM-adjusted cohort confirmed similar survival in both cohorts (log-rank, 3.34; P = 0.068; HR 1.382; 95% CI 0.97-1.95; P = 0.069). CONCLUSIONS: When comparing properly matched patient groups, patients who return to HD after KAF present similar survival than survival than transplant-naïve incident patients.
Authors: Ekamol Tantisattamo; Ramy M Hanna; Uttam G Reddy; Hirohito Ichii; Donald C Dafoe; Gabriel M Danovitch; Kamyar Kalantar-Zadeh Journal: Curr Opin Nephrol Hypertens Date: 2020-01 Impact factor: 3.416
Authors: Covadonga López Del Moral Cuesta; Sandra Guiral Foz; David Gómez Pereda; José Luis Pérez Canga; Marina de Cos Gómez; Jaime Mazón Ruiz; Ana García Santiago; José Iñigo Romón Alonso; Rosalía Valero San Cecilio; Emilio Rodrigo Calabia; David San Segundo Arribas; Marcos López Hoyos; Juan Carlos Ruiz San Millán Journal: Biomedicines Date: 2020-03-28