Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Inrig, Jula K.; Sun, Jie; Yang, Qinghong; Briley, Libbie P.; Szczech, Lynda A.

doi:10.2215/cjn.00580705

Cited by 46 publications

(32 citation statements)

References 37 publications

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“…20 The small In Brazil, men represent the majority (57%) of new patients, a fi nding similar to international studies. 8,9,19 The main cause of CKD identifi ed by our study was hypertension, followed by diabetes, in contrast to other studies performed in countries of America, 6,8,9,19 in which diabetes was identifi ed as the leading cause. The differences observed between the studies may be the result of diffi culties in establishing a precise diagnosis of this disease in Brazil, which can be inferred from the high percentage of indeterminate causes.…”

Section: Discussioncontrasting

confidence: 83%

“…Nonetheless, recent studies suggest greater survival on PD in the fi rst year of RRT, followed by an equivalent survival between the modalities. 8,22 It is necessary to have reliable and available databases about RRT in Brazil, since they are fundamental for recognizing various aspects of chronic renal disease, such as prevalence, incidence, mortality and factors that infl uence its development. The systematic collection of data about the patients on dialysis remains a challenge in the majority of countries.…”

Section: Discussionmentioning

confidence: 99%

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Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

et al. 2010

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OBJECTIVE:To describe the clinical and epidemiological profi le of patients under renal replacement therapies, identifying risk factors for death. METHODS:This is a non-concurrent cohort study of data for 90,356 patients in the National Renal Replacement Therapies Database. A deterministicprobabilistic linkage was performed using the Authorization System for High Complexity/Cost Procedures and the Mortality Information System databases. All patients who started dialysis between 1/1/2000 and 12/31/2004 were included and followed until death or the end of 2004. Age, sex, region of residence, primary renal disease and causes of death were analyzed. A proportional hazards model was used to identify factors associated with risk of death. RESULTS:The prevalence of patients under renal replacement therapies increased an average of 5.5%, while incidence remained stable during the period. Hemodialysis was the predominant initial modality (89%). The patients were majority male with mean age 53 years, residents of the Southeast region and presented unknown causes as the main cause of chronic renal disease, followed by hypertension, diabetes and glomerulonephritis. Of these patients, 42% progressed to death and 7% underwent kidney transplantation. The patients on peritoneal dialysis were older and had higher prevalence of diabetes. The death rate varied from 7% among transplanted patients to 45% among non-transplanted patients. In the fi nal Cox proportional hazards model, the risk of mortality was associated with increasing age, female sex, having diabetes, living in the North and Northeast region, peritoneal dialysis as a fi rst modality and not having renal transplantation. CONCLUSIONS:There was an increased prevalence of patients on renal therapy in Brazil. Increased risk of death was associated with advanced age, diabetes, the female sex, residents of the North and Northeast region and lack of renal transplant.

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Section: Discussioncontrasting

confidence: 83%

Section: Discussionmentioning

confidence: 99%

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

et al. 2010

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“…21 A higher mortality risk with PD in the 7-to 12-mo period was seen among patients with but not without diabetes in an inception cohort of Ն65-yr-old people in New Jersey, although the study power did not exclude an effect size similar to ours. 22 A different approach to confounding-restriction-was taken by Inrig et al, 23 whose cohort was limited to those accepted onto the transplant waiting list. Not surprising, the absolute mortality rates were lower, but worse outcomes remained among people treated with PD, again with an interaction with obesity.…”

Section: Discussionmentioning

confidence: 99%

Relationship between Dialysis Modality and Mortality

McDonald¹,

Marshall²,

Johnson³

et al. 2009

Journal of the American Society of Nephrology

286

229

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Mortality differences between peritoneal dialysis (PD) and hemodialysis (HD) are widely debated. In this study, mortality was compared between patients treated with PD and HD (including home HD) using data from 27,015 patients in the Australia and New Zealand Dialysis and Transplant Registry, 25,287 of whom were still receiving PD or HD 90 d after entry into the registry. Overall mortality rates were significantly lower during the 90-to 365-d period among those being treated with PD at day 90 (adjusted hazard ratio [HR] 0.89; 95% confidence interval [CI] 0.81 to 0.99]; P Ͻ 0.001). This effect, however, varied in direction and size with the presence of comorbidities: Younger patients without comorbidities had a mortality advantage with PD treatment, but other groups did not. After 12 mo, the use of PD at day 90 was associated with significantly increased mortality (adjusted HR 1.33; 95% CI 1.24 to 1.42; P Ͻ 0.001). In a supplementary as-treated analysis, PD treatment was associated with lower mortality during the first 90 d (adjusted HR 0.67; 95% CI 0.56 to 0.81; P Ͻ 0.001). These data suggest that the effect of dialysis modality on survival for an individual depends on time, age, and presence of comorbidities. Treatment with PD may be advantageous initially but may be associated with higher mortality after 12 mo.

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“…The length of survival obtained with hemodialysis or peritoneal dialysis is similar. 2 However, survival is not the only expected result. According to Socrates, "We should place the highest value not on living, but on living well.…”

Section: Introductionmentioning

confidence: 99%

Predictors of quality of life among patients on dialysis in southern Brazil

et al. 2008

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CONTEXT AND OBJECTIVE: Quality of life (QoL) is considered important as an outcome measurement, especially for long-term diseases such as chronic renal failure. The present study searched for predictors of QoL in a sample of patients undergoing dialysis in southern Brazil. DESIGN AND SETTING:This was a cross-sectional study developed in three southern Brazilian dialysis facilities.METHODS: Health-related QoL of patients on hemodialysis or peritoneal dialysis was measured using the generic Short Form-36 (SF-36) health survey questionnaire. The results were correlated with sociodemographic, clinical and laboratory variables. The analysis was adjusted through multiple linear regression. RESULTS:A total of 140 patients were assessed: 94 on hemodialysis and 46 on peritoneal dialysis. The mean age was 54.2 ± 15.4 years, 48% were men and 76% were white. The predictors of higher (better) physical component summary in SF-36 were: younger age (β -0.16; 95% confi dence interval, CI: -0.27 to -0.05), shorter time on dialysis (β -0.06; 95% CI: -0.09 to -0.02) and lower Khan comorbidity-age index (β 5.16; 95% CI: 1.7-8.6). The predictors of higher mental component summary were: being employed (β 8.4; 95% CI: 1.7-15.1), being married or having a marriage-like relationship (β 4.56; 95% CI: 0.9-8.2), being on peritoneal dialysis (β 4.9; 95% CI: 0.9-8.8) and not having high blood pressure (β 3.9; 95% CI: 0.3-7.6).CONCLUSIONS: Age, comorbidity and length of time on dialysis were the main predictors of physical QoL, whereas socioeconomic issues especially determined mental QoL.

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Mortality by Dialysis Modality among Patients Who Have End-Stage Renal Disease and Are Awaiting Renal Transplantation

Cited by 46 publications

References 37 publications

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

Perfil epidemiológico dos pacientes em terapia renal substitutiva no Brasil, 2000-2004

Relationship between Dialysis Modality and Mortality

Predictors of quality of life among patients on dialysis in southern Brazil

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