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Association between estimated glomerular filtration rate at initiation of dialysis and mortality
- Source :
- Canadian Medical Association Journal. 183:47-53
- Publication Year :
- 2010
- Publisher :
- CMA Joule Inc., 2010.
-
Abstract
- Background Recent studies have reported a trend toward earlier initiation of dialysis (i.e., at higher levels of glomerular filtration rate) and an association between early initiation and increased risk of death. We examined trends in initiation of hemodialysis within Canada and compared the risk of death between patients with early and late initiation of dialysis. Methods The analytic cohort consisted of 25 910 patients at least 18 years of age who initiated hemodialysis, as identified from the Canadian Organ Replacement Register (2001–2007). We defined the initiation of dialysis as early if the estimated glomerular filtration rate was greater than 10.5 mL/min per 1.73 m 2 . We fitted time-dependent proportional-hazards Cox models to compare the risk of death between patients with early and late initiation of dialysis. Results Between 2001 and 2007, mean estimated glomerular filtration rate at initiation of dialysis increased from 9.3 (standard deviation [SD] 5.2) to 10.2 (SD 7.1) ( p 2 among those with early initiation and 7.1 (SD 2.0) mL/min per 1.73 m 2 among those with late initiation. The unadjusted hazard ratio (HR) for mortality with early relative to late initiation was 1.48 (95% CI 1.43–1.54). The HR decreased to 1.18 (95% CI 1.13–1.23) after adjustment for demographic characteristics, serum albumin, primary cause of end-stage renal disease, vascular access type, comorbidities, late referral and transplant status. The mortality differential between early and late initiation per 1000 patient-years narrowed after one year of follow-up, but never crossed and began widening again after 24 months of follow-up. The differences were significant at 6, 12, 30 and 36 months. Interpretation In Canada, dialysis is being initiated at increasingly higher levels of glomerular filtration rate. A higher glomerular filtration rate at initiation of dialysis is associated with an increased risk of death that is not fully explained by differences in baseline characteristics.
- Subjects :
- medicine.medical_specialty
business.industry
Proportional hazards model
Research
Patient Selection
medicine.medical_treatment
Hazard ratio
Renal function
Retrospective cohort study
General Medicine
Surgery
Renal Dialysis
Internal medicine
Cohort
medicine
Humans
Kidney Diseases
Hemodialysis
business
Survival rate
Dialysis
Glomerular Filtration Rate
Subjects
Details
- ISSN :
- 14882329 and 08203946
- Volume :
- 183
- Database :
- OpenAIRE
- Journal :
- Canadian Medical Association Journal
- Accession number :
- edsair.doi.dedup.....9f8db1dca4ba82488131a2336d1c4a13