Early mortality in dialysis and adequacy of predialysis renal care: the picture is more complex than we thought

Rognant, Nicolas; Laville, Maurice

doi:10.1038/ki.2014.82

Cited by 10 publications

(6 citation statements)

References 16 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…We also do not have data on several parameters that may have implications for the interpretation of CVEs, including first presentation to nephrologists, the level of renal function at dialysis initiation, the specific indication for starting dialysis, or residual renal function. 25 As patients were enrolled at presentation to a dialysis provider, we are unable to compare event rates after dialysis initiation with event rates during the pre-dialysis period. The AROii study represents a random sample drawn from European FME centers to minimize selection bias, but the findings may not be generalizable for patients under the care of other providers.…”

Section: Discussionmentioning

confidence: 99%

High cardiovascular event rates occur within the first weeks of starting hemodialysis

Eckardt

Gillespie

Kronenberg

et al. 2015

Kidney International

104

View full text Add to dashboard Cite

Early mortality is high in hemodialysis (HD) patients, but little is known about early cardiovascular event (CVE) rates after HD initiation. To study this we analyzed data in the AROii cohort of incident HD patients from over 300 European Fresenius Medical Care dialysis centers. Weekly rates of a composite of CVEs during the first year and monthly rates of the composite and its constituents (coronary artery, cerebrovascular, peripheral arterial, congestive heart failure, and sudden cardiac death) during the first 2 years after HD initiation were assessed. Of 6308 patients that started dialysis within 7 days, 1449 patients experienced 2405 CVEs over the next 2 years. The first-year CVE rate (30.2/100 person-years; 95% CI, 28.7–31.7) greatly exceeded the second-year rate (19.4/100; 95% CI, 18.1–20.8). Composite CVEs were highest during the first week with increased risk compared with the second year, persisting until the fifth month. Except for sudden cardiac death, temporal patterns of rates for all CVE categories were very similar, with highest rates during the first month and a high-risk period extending to 4 months. Higher or lower cumulative weekly dialysis dose, lower blood flow, and lower net ultrafiltration during dialysis were associated with CVE during the high-risk period, but not during the post high-risk period. Thus, the incidence of CVE in the first weeks after HD initiation is much higher than during subsequent periods which raises concerns that HD initiation may trigger CVEs.

show abstract

Section: Discussionmentioning

confidence: 99%

High cardiovascular event rates occur within the first weeks of starting hemodialysis

Eckardt

Gillespie

Kronenberg

et al. 2015

Kidney International

104

View full text Add to dashboard Cite

show abstract

“…Esto es relevante ya que se ha sugerido que una inadecuada preparación previa a la diálisis está relacionada con mayor mortalidad (17,19) . De tal forma que los factores asociados a la mortalidad temprana nos puede dar una idea de las condiciones en las que los pacientes llegan a diálisis y ser una forma indirecta de evaluar nuestro sistema de salud para con nuestros pacientes con ERC (4,5) .…”

Section: Discussionunclassified

“…Se ha sugerido que los factores asociados a la mortalidad temprana dependerían de las condiciones clínicas en las que el paciente inicia la terapia; esto indirectamente está relacionado con la estructura de la atención de los pacientes con enfermedad renal crónica (ERC) en un sistema de salud (5,6) .…”

Section: Introductionunclassified

Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú

Herrera‐Añazco

Benítes-Zapata

Hernández

2015

Rev Peru Med Exp Salud Publica

View full text Add to dashboard Cite

RESUMENObjetivos. Determinar los factores asociados a la mortalidad durante la primera hospitalización de una población incidente en hemodiálisis. Materiales y métodos. Estudio observacional y retrospectivo de pacientes que ingresaron al Hospital Nacional Dos de Mayo entre enero de 2012 y diciembre de 2013. Para el análisis de la supervivencia utilizamos el método de Kaplan-Meier. Se realizó un análisis de regresión logístico multivariado para evaluar los factores asociados a mortalidad intrahospitalaria. Resultados. Se estudiaron 216 pacientes con edad promedio de 56,9 ± 15,5 años. El 24% de los paciente (n=51) fallecieron durante la estancia hospitalaria. La tasa de mortalidad fue de 9,3 muertes/100 personas-semanas (IC 95%: 7,0 a 12,3). Se evidenció una tendencia a menor riesgo de fallecer en pacientes que tenían entre uno y seis meses con diagnóstico de enfermedad renal crónica (OR 0,84; IC 95%: 0,32 a 2,26), y en aquellos con más de seis meses comparado con aquellos que lo tenían hace menos de un mes (OR 0,55; IC 95%: 0,19 a 1,57). La atención previa por un nefrólogo no estuvo asociada a diferencias en la mortalidad menor (OR 1,14; IC 95%: 0,39 a 3,31). Conclusiones. Existe una deficiente atención previa entre los pacientes en hemodiálisis que forman parte de una inadecuada estructura de atención de salud y que está asociado a una alta mortalidad intrahospitalaria. Palabras clave: Mortalidad; Hemodiálisis; Sistemas de salud (fuente: DECS/Bireme) FACTORS ASSOCIATED WITH IN HOSPITAL DEATHS IN A HEMODIALYSIS POPULATION IN PERU ABSTRACTObjectives. To determine the factors associated with mortality during the first hospitalization of patients admitted to a hemodialysis unit. Materials and methods. Observational and retrospective study of patients admitted to "Dos de Mayo" National Hospital between January 2012 and December 2013. For the survival analysis we used the Kaplan-Meier method. A multivariate logistic regression was performed to evaluate the factors associated with hospital mortality. Results. 216 patients with a mean age of 56.9 ± 15.5 years were studied. 24% of patients (n = 51) died during their hospital stay. The mortality rate was 9.3 deaths/100 person-weeks (95% CI: 7.0 to 12.3). We found a tendency of less risk of death in patients with between 1 and 6 months from chronic kidney disease diagnosis (OR 0.84, 95% CI: 0.32 to 2.26) and in those with more than six months from chronic kidney disease diagnosis compared with those who had less than a month from chronic kidney disease diagnosis (OR 0.55, 95% CI: 0.19 to 1.57). Previous care by a nephrologist was not associated with differences in lower mortality (OR 1.14, 95% CI: 0.39 to 3.31). Conclusions. There is poor prior care among hemodialysis patients that form part of an inadequate health care structure and this is associated with high inhospital mortality.

show abstract

“…Although results from previous studies mostly support the notion that nephrology care during the pre-ESKD phase may be associated with survival benefits after dialysis is initiated [6][7][8], optimal nephrology care intervals, visits, and contents could be influenced by reimbursement policy and are yet to be determined. In general, timely nephrology referral, regular nephrology care visits, and multidisciplinary care were suggested when patients' glomerular filtration rate reached 30 mL/min/1.73 m 2 or below, or for patients facing uncontrollable renal disease deterioration [9,10]. However, arbitrarily categorizing the timing of nephrology referral as early or late, and determining nephrology care in short time windows, may lose accuracy in quantifying the effects of nephrology care on patient benefits after dialysis.…”

Section: Introductionmentioning

confidence: 99%

Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study

Chung

Chiu

et al. 2021

JPM

View full text Add to dashboard Cite

Long-term and continuous nephrology care effects on post-dialysis mortality remain unclear. This study aims to systematically explore the causal effect of nephrology care on mortality for patients with dialysis initiation. We conducted a retrospective cohort study to include incident patients with dialysis for ≥ 3 months in Taiwan from 2004 through 2011. The continuous nephrology care of incident patients in the three years before their dialysis was measured every six months. Continuous nephrology care was determined by 0–6, 0–12, …, 0–36 months and their counterparts; and none, intermittent, 0–6 months, …, and 0–36 months. Simple and weighted hazards ratio (HR) and 95% confidence interval (CI) for one-year mortality were estimated after propensity score (PS) matching. We included a total of 44,698 patients (mean age 63.3 ± 14.2, male 51.9%). Receiving ≥ 1 year predialysis nephrology care was associated with a 22% lower post-dialysis mortality hazard. No different effects were found (ranges of PS matching HR: 0.77–0.80) when comparing the defined duration of nephrology care with their counterparts. Stepped survival benefits were newly identified in the intermittent care, which had slightly lower HRs (weighted HR: 0.88, 95% CI: 0.79–0.97), followed by reviving care over six months to two years (ranges of weighted HR: 0.60–0.65), and reviving care over two years (ranges of weighted HR: 0.48–0.52). There was no existing critical period of nephrology care effect on post-dialysis, but there were extra survival benefits when extending nephrology care to >2 years, which suggests that continuous and long-term care during pre-dialysis/chronic kidney disease phase is required.

show abstract

Early mortality in dialysis and adequacy of predialysis renal care: the picture is more complex than we thought

Cited by 10 publications

References 16 publications

High cardiovascular event rates occur within the first weeks of starting hemodialysis

High cardiovascular event rates occur within the first weeks of starting hemodialysis

Factores asociados a mortalidad intrahospitalaria de una población en hemodiálisis en el Perú

Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study

Contact Info

Product

Resources

About