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Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study
| Content Provider | Scilit |
|---|---|
| Author | Rivara, Matthew B. Chen, Chang Huei Nair, Anupama Cobb, Denise Himmelfarb, Jonathan Mehrotra, Rajnish |
| Copyright Year | 2017 |
| Description | Journal: American Journal of Kidney Diseases 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. |
| Related Links | http://europepmc.org/articles/pmc5182162?pdf=render https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5182162/pdf http://www.ajkd.org/article/S0272638616303493/pdf |
| Ending Page | 50 |
| Page Count | 10 |
| Starting Page | 41 |
| ISSN | 02726386 |
| e-ISSN | 15236838 |
| DOI | 10.1053/j.ajkd.2016.06.024 |
| Journal | American Journal of Kidney Diseases |
| Issue Number | 1 |
| Volume Number | 69 |
| Language | English |
| Publisher | Elsevier BV |
| Publisher Date | 2017-01-01 |
| Access Restriction | Open |
| Subject Keyword | Journal: American Journal of Kidney Diseases Endocrinology and Metabolism End-stage Renal Disease (esrd) Peritoneal Dialysis Dialysis Initiation All-cause Mortality Chronic Kidney Failure Indications for Renal Replacement Therapy Clinical Decision Making |
| Content Type | Text |
| Resource Type | Article |
| Subject | Nephrology |
