Markers for survival in dialysis: A seven-year prospective study

Avram, Morrell M.; Mittman, Neal; Bonomini, Luigi; Chattopadhyay, Jyotiprakas; Fein, Paul A.

doi:10.1016/0272-6386(95)90176-0

Cited by 211 publications

(98 citation statements)

References 26 publications

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“…In dialysis patients, variation in GFR likely contributes less to variation in serum creatinine levels than to variation in its non-GFR determinants (muscle mass and nutritional status). 26,27 In our study, adjustment for variables in addition to GFR removed the inverse association between creatinine and mortality, suggesting that these other variables may be associated with the non-GFR determinants of serum creatinine. The inverse relationship was not observed for kidney failure, even after accounting for GFR and potential non-GFR determinants, likely reflecting bias arising from the clinicians' use of serum creatinine in the decision of when to start dialysis, despite guidelines that recommend a symptomguided approach to initiation of renal replacement therapy.…”

Section: Discussionmentioning

confidence: 51%

Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate

Tangri

Inker

Tighiouart

et al. 2012

Journal of the American Society of Nephrology

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Serum levels of creatinine, cystatin C, or b trace protein allow estimation of GFR, but whether these markers contribute additional prognostic information beyond that reflected in GFR is unknown. Here, we analyzed data from the Modification of Diet in Renal Disease study, which provided baseline levels of these markers for 816 participants with a median follow-up of 16.6 years. We examined associations between the reciprocals of these filtration markers and 125 I iothalamate GFR, expressed per SD, with kidney failure and mortality. In univariate analysis, lower GFR and higher levels of each filtration marker associated with a higher risk for all outcomes. After adjustment for GFR in a Cox proportional hazards model, higher creatinine associated with a higher risk for kidney failure but a lower risk for all-cause mortality. Higher cystatin C and b trace protein associated with a higher risk for both kidney failure and all-cause mortality. In models including either cystatin C or b trace protein, the association of GFR with all-cause mortality was no longer significant after the addition of the filtration marker, suggesting the possibility of multicollinearity. In summary, after adjustment for GFR, levels of creatinine, cystatin C, and b trace protein, each remained directly associated with kidney failure but differed with respect to their associations with mortality. These differences may be a result of non-GFR-related associations of filtration markers, residual confounding by GFR, or collinearity between the filtration markers and GFR. b trace protein and cystatin C seem to provide more consistent prognostic information than creatinine.

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Section: Discussionmentioning

confidence: 51%

Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate

Tangri

Inker

Tighiouart

et al. 2012

Journal of the American Society of Nephrology

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“…The association between these markers and mortality has been recognized for over a decade and this has been confirmed. [27][28][29] In this multivariate analysis, TA albumin was not associated with mortality for PD patients. Our data showed that the TA albumin decreased as the grade of the Davies index increased.…”

Section: Discussionmentioning

confidence: 57%

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

et al. 2012

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Background: The mortality rates of end-stage renal disease patients have significantly declined over the past decade. However, there are few reports on the risk factors for mortality in stable peritoneal dialysis (PD) patients who survive for a considerable time. Patients and methods: We reviewed the medical records and identified all adult patients who received PD between April 2001 and March 2009 in our institution. The total cohort was 550 patients. Among these patients, 383 patients were enrolled as stable PD patients. Results: The cumulative survival of the stable PD patients was 91.6% at 3 years and 78.7% at 5 years. On univariate analysis, old age (≥65 years of age), hypoalbuminemia (<35 g/L), log C-reactive protein (CRP) (≥0.84), phosphorus (<1.13 mmol/L), statin, icodextrin, and the Davies index were associated with mortality for all PD patients. Old age, hypoalbuminemia, log CRP, phosphorus, the residual renal function (RRF) (≤4 mL/min/1.73 m 2 ) at 24 months, renin-angiotensin system blockade, icodextrin, and the Davies index were associated with mortality for the stable PD patients. Multivariate analysis showed that, among the variables, age, log CRP, phosphorus, initial RRF, and the Davies index were associated with mortality for all PD patients. In stable PD patients, age, log CRP, phosphorus, RRF at 24 months, and the Davies index were associated with mortality. Conclusion: Initial high RRF combined with the RRF preservation, maintenance of proper phosphorus, control of inflammation, and proper management of comorbidities may help to improve the survival of PD patients including stable PD patients.

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“…It has been reported that residual renal function and serum albumin are both important predictors for patient survival (26)(27)(28)(29)(30). On the other hand, our urgentstart patients were also younger, and so the risk of death was partly offset.…”

Section: Discussionmentioning

confidence: 79%

Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

et al. 2014

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♦ Objectives: Peritoneal dialysis (PD) is one of the firstline modalities of renal replacement therapy in patients with end-stage renal disease. Guidelines recommended a break-in period of at least 2 weeks before full PD start. However, the optimal duration of the break-in period is still unclear. In the present study, we investigated the effect of various break-in periods on short-term outcomes in patients on PD.

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Markers for survival in dialysis: A seven-year prospective study

Cited by 211 publications

References 26 publications

Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate

Filtration Markers May Have Prognostic Value Independent of Glomerular Filtration Rate

Risk Factors for Mortality in Stable Peritoneal Dialysis Patients

Impact of Break-In Period on the Short-Term Outcomes of Patients Started on Peritoneal Dialysis

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