International Hemodialysis Patient Outcomes Comparisons Revisited

Robinson, Bruce M.; Port, Friedrich K.

doi:10.2215/cjn.04720709

Cited by 40 publications

(28 citation statements)

References 18 publications

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“…Lastly, primary outcome in the present study was relatively small compared to those in previous studies on Western ESRD patients. We hypothesize that the difference is mainly attributed to disparate ethnicities, since the mortality rates of our patients were comparable to those of Japanese patients on HD [35]. Despite these limitations, the current study investigated the association of IDWG with various nutritional and inflammatory parameters, and RRF.…”

Section: Discussionmentioning

confidence: 94%

Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

et al. 2014

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Background: Interdialytic weight gain (IDWG) has been regarded as a surrogate of volume overload, but also as a marker of a better nutritional status in end-stage renal disease (ESRD) patients on hemodialysis (HD). This paradoxical meaning of IDWG requires further investigation, particularly in adverse cardiovascular outcomes. Methods: A prospective cohort of 1,013 incident HD patients from 36 HD centers of the Clinical Research Center for ESRD in Korea was included. Patients were categorized into five groups according to the IDWG%, a ratio of absolute IDWG to dry weight: <1.0, ≥4.0, and every 1.0 increment in between. Primary outcome was major adverse cardiac and cerebrovascular events (MACCE). Results: During a mean follow-up of 18.7 months, primary outcome was observed in 104 patients (10.3%). In multivariate analysis, compared to patients with IDWG% of 1.0-1.9 (reference group), the hazard ratios (HRs) for primary outcome in the IDWG% <1.0, 2.0-2.9, 3.0-3.9, and ≥4.0 groups were 1.10 [95% confidence interval (CI) 0.55-2.20, p = 0.80], 1.15 (95% CI 0.59-2.27, p = 0.68), 1.80 (95% CI 0.95-3.41, p = 0.07), and 1.93 (95% CI 1.02-3.64, p = 0.04), respectively. Furthermore, even when residual renal function and 24-hour urine volume were adjusted, IDWG% ≥4.0 remained as a significant predictor of primary outcome (HR 2.03, 95% CI 1.02-4.02, p = 0.04). Conclusion: Increased IDWG% is a significant independent predictor of MACCE in incident HD patients. It could be helpful to prevent excessive IDWG for improving clinical outcomes in incident HD patients.

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Section: Discussionmentioning

confidence: 94%

Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

et al. 2014

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“…It became clear in the Dialysis Outcomes and Practice Patterns Study (DOPPS) that the prognoses of patients on maintenance dialysis differ among countries and are associated with differences in practice patterns [10]. Given the lack of information about SES and clinical outcomes for maintenance hemodialysis patients in Japan, we used the Japan DOPPS (J-DOPPS) to investigate associations of SES with mortality and hospitalization with particular focus on employment and education.…”

Section: Introductionmentioning

confidence: 99%

Associations of employment status and educational levels with mortality and hospitalization in the dialysis outcomes and practice patterns study in Japan

et al. 2017

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BackgroundSocioeconomic status (SES) factors such as employment, educational attainment, income, and marital status can affect the health and well-being of the general population and have been associated with the prevalence of chronic kidney disease (CKD). However, no studies to date in Japan have reported on the prognosis of patients with CKD with respect to SES. This study aimed to investigate the influences of employment and education level on mortality and hospitalization among maintenance hemodialysis (HD) patients in Japan.MethodsData on 7974 HD patients enrolled in Dialysis Outcomes and Practice Patterns Study phases 1–4 (1999–2011) in Japan were analysed. Employment status, education level, demographic data, and comorbidities were abstracted at entry into DOPPS from patient records. Mortality and hospitalization events were collected during follow-up. Patients on dialysis < 120 days at study entry were excluded from the analyses. Cox regression modelled the association between employment and both mortality and hospitalization among patients < 60 years old. The association between education and outcomes was also assessed. The association between patient characteristics and employment among patients < 60 years old was assessed using logistic regression.ResultsDuring a median follow-up of 24.9 months (interquartile range, 18.4–32.0), 10% of patients died and 43% of patients had an inpatient hospitalization. Unemployment was associated with mortality (hazard ratio [HR] = 1.57; 95% confidence interval [CI]: 1.05–2.36) and hospitalization (HR = 1.25; 95% CI: 1.08–1.44). Compared to patients who graduated from university, patients with less than a high school (HS) education and patients who graduated HS with some college tended to have elevated mortality (HR = 1.41; 95% CI, 1.04–1.92 and HR = 1.36; 95% CI: 1.02–1.82, respectively) but were not at risk for increased hospitalizations. Factors associated with unemployment included lower level of education, older age, female gender, longer vintage, and several comorbidities.ConclusionsEmployment and education status were inversely associated with mortality in patients on maintenance HD in Japan. Employment but not education was also inversely associated with hospitalizations. After adjustment for comorbidities, the associations with clinical outcomes tended to be stronger for employment than education status.

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“…The latter has shown to be related to mortality on dialysis (1,2,44). Considering the quality of dialysis care pathway, we hypothesized that macroeconomic indicators and the organization of renal services may directly be linked with the quality of dialysis care, something that has previously been known to be related to mortality on dialysis (10,44,45).…”

Section: Discussionmentioning

confidence: 99%

Exploring the Association between Macroeconomic Indicators and Dialysis Mortality

Kramer¹,

Stel²,

Caskey³

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population. Design, setting, participants, & measurements Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003–2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log–log transformation of the outcome variable was applied to establish factors associated with survival on dialysis. Results Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis. Conclusions Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.

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International Hemodialysis Patient Outcomes Comparisons Revisited

Cited by 40 publications

References 18 publications

Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

Interdialytic Weight Gain and Cardiovascular Outcome in Incident Hemodialysis Patients

Associations of employment status and educational levels with mortality and hospitalization in the dialysis outcomes and practice patterns study in Japan

Exploring the Association between Macroeconomic Indicators and Dialysis Mortality

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