Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Nee, Robert; Fisher, E.S.; Yuan, Christina M.; Agodoa, Lawrence Y.; Abbott, Kevin C.

doi:10.1159/000475767

Cited by 18 publications

(15 citation statements)

References 35 publications

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“…The 32 studies included in this review represent a combined population of 1 083 264 new dialysis starters and 283 277 person‐years of observation for early mortality. The characteristics of these studies are shown in Table .…”

Section: Resultsmentioning

confidence: 99%

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Hazara

Bhandari

2019

Ther Apher Dial

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Mortality rates are reported to be high soon after the commencement of maintenance HD for ESRD. Our aim was to estimate early mortality rates (deaths within 180 days of starting therapy), through a systematic review of literature, in this patient population. Medline and EMBASE were searched for publications between 1 January 1985 and 31 December 2017. Observational studies reporting deaths involving adults commencing HD were included. The Quality in Prognosis Studies tool was used to assess risk of bias in studies. Crude mortality rates (expressed in 100 person-years) and age-standardized mortality ratios (SMR) were calculated. Meta-analyses of these rates were conducted for studies with lowest risk of bias (i.e. highest quality). In total, 32 studies were included (combined population: 1 083 264) representing 283 277 person-years of observation; median follow-up: 90 days. Mortality rates ranged between 12.8 and 55.6 per 100 person-years. Cardiovascular causes accounted for the majority of early deaths. Meta-analysis of high-quality studies showed an overall crude mortality rate of 32.6 per 100 person-years (95% CI 32.4-32.8). This equates to 16.3% mortality in first 180 days of starting HD. Six highquality studies contained sufficient data for calculation of SMR. Meta-analysis of SMRs showed that patients starting HD therapy sustain 8.8 times higher mortality rates compared to the general population. We have combined the results of high-quality studies to produce new estimates of early mortality rates after commencement of HD therapy. This information can help relay more reliable prognostic information to this patient population.

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Section: Resultsmentioning

confidence: 99%

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Hazara

Bhandari

2019

Ther Apher Dial

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“…Not surprisingly, the presence of a maturing AVF/G was more frequent in patients with early access to nephrology care, which is an aspect of pre-ESRD nephrology care that has been underappreciated, although this association has already been shown for presence of mature AVF. [10][11][12] A maturing AVF/G represents a 'near-miss', and future work should involve developing strategies to promote timely AVF/G placement that enables patients to avoid CVC Figure 1. Comparison of the time to transition from a dialysis catheter to a working arteriovenous fistula or graft, between patients with a maturing AVF or AVG at HD initiation and those with a catheter as the sole vascular access.…”

Section: Discussionmentioning

confidence: 99%

Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

McGill

Lacson

2019

J Vasc Access

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Introduction: Nephrologists have increased arteriovenous access placement in patients with chronic kidney disease. Not yet usable ‘maturing’ arteriovenous fistulas and grafts are nearly as common as mature arteriovenous fistulas or grafts. Little has been reported about patients initiating haemodialysis with unready arteriovenous fistulas or grafts. Methods: The United States Renal Data System records for all adult patients initiating haemodialysis with central venous catheters between July 2010 and December 2011. Patients were categorized by whether a maturing arteriovenous fistula or graft was present. Transition to working arteriovenous fistula or graft was determined from linked Medicare claims. Modality changes and survival were ascertained. A logistic model for one-year survival and a subdistribution hazards model for transition to working arteriovenous fistula or graft, accounting for the competing risk of death, were constructed. Results: Compared to central venous catheter-only, maturing arteriovenous fistula or graft was associated with access conversion (hazard ratio = 2.23 (2.17–2.30) and 3.25 (2.97–3.56), respectively, p < 0.001 for both). Median time to conversion, among those who transitioned, was 95 days (interquartile range = 56–139) for patients with a maturing arteriovenous graft and 135 days (98–198) with a maturing arteriovenous fistula, versus 193 days (138–256) with central venous catheter-only. Pre-dialysis nephrology care, male sex and non-Caucasian race were associated with access conversion. Patients without a maturing arteriovenous fistula or graft had decreased odds of one-year survival (odds ratio = 0.61 (0.58–0.66), p < 0.001), which attenuated with adjustment for access conversion (adjusted odds ratio = 1.06 (0.98–1.13), p = 0.2). Conclusion: Maturing arteriovenous fistulas or grafts were associated with enhanced first-year survival and increased opportunity for working arteriovenous fistulas or grafts, which may reflect pre-dialysis decision-making, quality of care and comorbid diseases. Central venous catheter exposure was substantial, even among patients with maturing access. Contributory factors prolonging conversion to arteriovenous access need to be identified and addressed.

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“…Pre-dialysis education programmes are now in widespread use across the renal community [1,2]. Informing patients through a shared decision-making process can influence patient treatment decisions and improve outcomes [3,4]. Shared decision making must be underpinned by robust outcome data presented in a way that is meaningful to patients and carers [5][6][7][8].…”

Section: Introductionmentioning

confidence: 99%

Exploring the choices and outcomes of older patients with advanced kidney disease

et al. 2020

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A lack of data on patient choices and outcomes at the time of pre-dialysis planning limits meaningful shared decision making, particularly in older frailer patients. In this large retrospective cohort study of patients aged over 70 seen by the pre-dialysis clinic (2004-2016) of a large single centre in the United Kingdom (1,216 patients), age, sex, comorbidity, poverty and frailty were used to predict choice of renal replacement therapy (RRT) over maximum conservative management (MCM). The impact of patient choice of RRT versus MCM was used to predict survival from the time of choice using multivariable Cox proportional hazards regression. Older age, female sex, greater poverty and greater frailty were associated with choosing MCM, whilst comorbidity had no significant impact on choice. At 5 years of follow up, 49% of all patients had died without receiving RRT. Over 70% of the patients choosing MCM died with better kidney function than the median level at which those starting RRT initiated treatment. Frailty and age were better predictors of survival than comorbidity and in patients with at least moderate frailty, RRT offered no survival benefit over MCM. In conclusion, analysing outcomes from the time of choice may improve shared decision making. Frailty should be routinely assessed and collected and further work may help predict which patients are unlikely to survive or progress to end stage renal disease and may not need to be burdened with making a pre-dialysis choice.

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Pre-End-Stage Renal Disease Care and Early Survival among Incident Dialysis Patients in the US Military Health System

Cited by 18 publications

References 35 publications

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Early Mortality Rates After Commencement of Maintenance Hemodialysis: A Systematic Review and Meta‐Analysis

Maturing arteriovenous accesses in incident haemodialysis patients and first-year outcomes

Exploring the choices and outcomes of older patients with advanced kidney disease

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