1. Registration on the Renal Transplantation Waiting List and Mortality on Dialysis: an Analysis of the French REIN Registry Using a Multi-state Model
- Author
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Jean-Baptiste Beuscart, Dominique Pagniez, Alain Duhamel, Eric Boulanger, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 (METRICS), Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), Interface sang vaisseaux et réparation cardiovasculaire, Université de Lille, Droit et Santé-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), We would like to thank the Scientific Committee and the people in charge of the REIN Registry for their invaluable assistance, in particular Dr. Cécile Couchoud, Mathilde Delasalle, and Dr. Christian Jacquelinet. We are also extremely grateful to all of the nephrologists and centers involved in this study for their kind cooperation and for providing high-quality data., Inserm, Université de Lille, CHU Lille, Evaluation des technologies de santé et des pratiques médicales - ULR 2694 [METRICS], Centre Hospitalier Régional Universitaire [Lille] [CHRU Lille], Lille Inflammation Research International Center - U 995 [LIRIC], Santé publique : épidémiologie et qualité des soins-EA 2694 (CERIM), Lille Inflammation Research International Center (LIRIC), Institut Pasteur de Lille, Réseau International des Instituts Pasteur (RIIP)-Réseau International des Instituts Pasteur (RIIP)-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Lille-Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille), and Centre Hospitalier Régional Universitaire [Lille] (CHRU Lille)-Université de Lille
- Subjects
Male ,Pediatrics ,Epidemiology ,medicine.medical_treatment ,[SDV]Life Sciences [q-bio] ,MESH: Registries ,030232 urology & nephrology ,MESH: waiting list ,MESH: Comorbidity ,Comorbidity ,01 natural sciences ,MESH: Regression Analysis ,MESH: Renal Dialysis/mortality ,010104 statistics & probability ,0302 clinical medicine ,Risk Factors ,MESH: Risk Factors ,MESH: Models ,Clinical Epidemiology ,Registries ,Kidney transplantation ,MESH: Waiting Lists ,MESH: Aged ,MESH: Middle Aged ,MESH: France/epidemiology ,MESH: kidney transplantation ,Hazard ratio ,General Medicine ,MESH: Follow-Up Studies ,waiting list ,Middle Aged ,3. Good health ,MESH: Survival Analysis ,Cohort ,Regression Analysis ,MESH: renal dialysis ,Original Article ,Female ,France ,Hemodialysis ,medicine.medical_specialty ,Waiting Lists ,Mesh:Female ,Mesh:Comorbidity ,Mesh:Follow-Up Studies ,Mesh:France/epidemiology ,Mesh:Humans ,Mesh:Kidney Transplantation ,Mesh:Male ,Mesh:Middle Aged ,Mesh:Models ,Mesh:Statistical ,Mesh:Registries ,Mesh:Regression Analysis ,Mesh:Renal Dialysis/mortality ,Mesh:Risk Factors ,Mesh:Survival Analysis ,Mesh:Waiting Lists ,Mesh:Aged ,survival analysis ,multi-state model ,renal dialysis ,kidney transplantation ,03 medical and health sciences ,Renal Dialysis ,medicine ,Humans ,MESH: multi-state model ,0101 mathematics ,MESH: Statistical ,Dialysis ,Survival analysis ,Aged ,Models, Statistical ,MESH: Humans ,business.industry ,medicine.disease ,Survival Analysis ,MESH: Male ,Transplantation ,business ,MESH: Female ,MESH: Kidney Transplantation ,Follow-Up Studies - Abstract
International audience; AbstractBackground: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration.Methods: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states (‘HD, not wait-listed’, ‘HD, wait-listed’, ‘death’, and ‘RT’) was used to estimate the effect of being wait-listed on the probability of death.Results: During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70–7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.Conclusions: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.
- Published
- 2015