Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model

Wal, Willem M. van der; Noordzij, Marlies; Dekker, Friedo W.; Boeschoten, E. W.; Krediet, Raymond T.; Korevaar, Joke C.; Geskus, Ronald B.

doi:10.1093/ndt/gfq856

Cited by 123 publications

(78 citation statements)

References 25 publications

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“…Patients with preserved urine output at 1 year, for example, have greater survival and less inflammation compared with patients with anuria. 33,34 Because over 50% of endogenous renal function may be lost in the first few months of hemodialysis treatment, 35 patients initiated early may experience a more rapid change in their inflammatory state relative to those patients initiated later who have lost residual function more gradually, which could increase early initiators' risk of morbidity and mortality. Additionally, this rapid loss of residual renal function could make early initiators more susceptible to deleterious electrolyte shifts during dialysis, which might explain our finding that risk of CV mortality (e.g., sudden cardiac death 36 ) was especially high among this population.…”

Section: Discussionmentioning

confidence: 99%

Predialysis Health, Dialysis Timing, and Outcomes among Older United States Adults

Crews

Scialla

Liu

et al. 2014

Journal of the American Society of Nephrology

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Studies of dialysis initiation timing have not accounted for predialysis clinical factors that could impact postdialysis outcomes. We examined the association of predialysis health with timing of dialysis initiation in older adult patients in the United States and contrasted morbidity and mortality outcomes among patients with early [estimated GFR (eGFR)$10 ml/min per 1.73 m 2 ] versus later (eGFR,10 ml/min per 1.73 m 2 ) initiation. We included all patients from the US Renal Data System who initiated dialysis between 2006 and 2008, were $67 years old, and had $2 years of prior Medicare coverage (n=84,654). We calculated patients' propensity to initiate dialysis early and matched patients by propensity scores. Cox models were used to compare risks of mortality and hospitalization among initiation groups. The majority (58%) of patients initiated dialysis early. Early initiators were more likely to have had AKI, multiple congestive heart failure admissions, and other hospitalizations preceding initiation. Among propensity-matched patients (n=61,930), early initiation associated with greater allcause (hazard ratio [HR], 1.11; 95% confidence interval [95% CI], 1.08 to 1.14), cardiovascular (CV; HR, 1.13; 95% CI, 1.09 to 1.17), and infectious (HR, 1.13; 95% CI, 1.06 to 1.22) mortality and greater all-cause (HR, 1.03; 95% CI, 1.01 to 1.05) and infectious (HR, 1.10; 95% CI, 1.07 to 1.13) hospitalizations. There was no difference in CV hospitalizations. Among these older adults, early dialysis initiation associates with greater mortality and hospitalizations, even after accounting for predialysis clinical factors. These findings do not support the common practice of early dialysis initiation in the United States. 25: 370-379, 201425: 370-379, . doi: 10.1681 There has been a global trend toward initiation of dialysis at higher levels of kidney function, particularly among older adults. 1 This trend may have been driven, in part, by clinicians' beliefs that earlier initiation could better preserve patients' nutritional status, thereby decreasing their risks of morbidity and mortality. [2][3][4] However, recent studies have questioned the ability of dialysis to prevent J Am Soc Nephrol

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Section: Discussionmentioning

confidence: 99%

Predialysis Health, Dialysis Timing, and Outcomes among Older United States Adults

Crews

Scialla

Liu

et al. 2014

Journal of the American Society of Nephrology

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“…However, loss of residual renal function is a serious issue, because it was reported that complete loss of glomerular filtration is associated with higher mortality. 56,57 Residual renal function is also important to regulate fluid volume and allow patients to have a larger fluid intake. The timing of renal TAE in each patient will depend on the symptoms associated with enlarged kidneys.…”

Section: Discussionmentioning

confidence: 99%

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Suwabe

Ubara

Mise

et al. 2015

JASN

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In patients with autosomal dominant polycystic kidney disease (ADPKD), massive renal enlargement is a serious problem. Renal transcatheter arterial embolization (TAE) can reduce renal volume (RV), but effectiveness varies widely, and the reasons remain unclear. We investigated factors affecting renal volume reduction rate (RVRR) after renal TAE in all 449 patients with ADPKD who received renal TAE at Toranomon Hospital from January of 2006 to July of 2013, including 228 men and 221 women (mean age =57.069.1 years old). One year after renal TAE, the RVRR ranged from 3.9% to 84.8%, and the least squares mean RVRR calculated using a linear mixed model was 45.5% (95% confidence interval [95% CI], 44.2% to 46.8%). Multivariate analysis using the linear mixed model revealed that RVRR was affected by the presence of large cysts with wall thickening (regression coefficient [RC], 26.10; 95% CI, 29.04 to 23.16; P,0.001), age (RC, 20.82; 95% CI, 21.03 to 20.60; P,0.001), dialysis duration (RC, 20.10; 95% CI, 20.18 to 20.03; P,0.01), systolic BP (RC, 0.39; 95% CI, 0.19 to 0.59; P,0.001), and the number of microcoils used for renal TAE (RC, 1.35; 95% CI, 0.83 to 1.86; P,0.001). Significantly more microcoils were needed to achieve renal TAE in patients with younger age and shorter dialysis duration. In conclusion, cyst wall thickening had an important effect on cyst volume reduction. Renal TAE was more effective in patients who were younger, had shorter dialysis duration, or had hypertension, parameters that might associate with cyst wall stiffness and renal artery blood flow.

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“…Indeed the importance of RFK is often ignored in HD treatment strategies, even though several studies have demonstrated a similar association between RKF loss and mortality or other important clinical outcomes in both PD and HD patients [9,10,11,12]. A more rapid decline in RKF has been noted among patients on HD compared to those on PD, and most patients nearly completely lose the RKF usually within the first year of dialysis therapy in incident HD patients [13,14,15].…”

Section: Introductionmentioning

confidence: 99%

“…A more rapid decline in RKF has been noted among patients on HD compared to those on PD, and most patients nearly completely lose the RKF usually within the first year of dialysis therapy in incident HD patients [13,14,15]. Potential predictors of decline in RKF in HD patients, as mentioned in the literature, are ESRD etiology, level of blood pressure (BP), intradialysis hypotension, extracellular fluid volume depletion, congestive heart failure, use of ultrapure dialysis fluid and biocompatible dialysis membranes; predictors of decline are also mentioned in the literature of various medications [6,7,8,9,10,11,12,13,14,15,16,17,18]. A recent study has showed that frequent nocturnal (six-times-per-week) HD was associated with faster RKF decline compared to conventional (three-times-per-week) HD [19].…”

Section: Introductionmentioning

confidence: 99%

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

et al. 2014

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Background: Residual kidney function (RKF) has consistently been a predictor of greater survival in maintenance hemodialysis (MHD) patients. The relationship between hemodialysis (HD) treatment frequency and RKF preservation has not been well examined. We hypothesized that initial twice-weekly HD helps in maintaining a longer RKF. Methods: In a dialysis center in Shanghai, 168 ESRD patients were screened and finally 85 patients were identified for this main cohort study. We first examined these 85 MHD patients; 30 of them were initiated with twice-weekly HD for 6 months or longer and 55 patients were started and maintained on thrice-weekly HD treatment. Then a subcohort study in 48 incident MHD patients was implemented to assess the independent risk factors responsible for RKF decline during the first year of HD therapy. Multivariate logistic regression analysis was then employed to examine the odds ratio of RKF loss. Results: The main cohort study showed that the clinical outcomes were almost the same between the two groups in 85 patients, but the percent of patients with RKF loss was significantly lower in the twice-weekly group compared with the thrice-weekly group, especially during the first year of HD initiation. In the 48 incident MHD patients, we found no significant differences between the two groups except for variations in the HD frequency, weekly Kt/V. The multivariate analysis showed that factors such as the male gender, HD frequency, URR and intradialytic hypotension episode were associated with RKF loss, and the odds ratio of RKF loss for each additional HD treatment per week was 7.2. Conclusion: Twice-weekly HD during the first year of dialysis therapy appears to be associated with better RKF preservation.

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Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model

Abstract: Preventing or delaying the full loss of GFR can improve survival in dialysis patients. This supports the importance that is given to the effect of treatment options for patients with ESRD on the rate of decline of the residual renal function.

Cited by 123 publications

References 25 publications

Predialysis Health, Dialysis Timing, and Outcomes among Older United States Adults

Predialysis Health, Dialysis Timing, and Outcomes among Older United States Adults

Suitability of Patients with Autosomal Dominant Polycystic Kidney Disease for Renal Transcatheter Arterial Embolization

Association of Initial Twice-Weekly Hemodialysis Treatment with Preservation of Residual Kidney Function in ESRD Patients

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