Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study

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• 作者：Matthew B. Rivara ; MD¹ ; ² ; ^mbr@uw.edu ; Chang Huei Chen ; MD² ; Anupama Nair ; MD² ; Denise Cobb ; RN³ ; Jonathan Himmelfarb ; MD¹ ; ² ; Rajnish Mehrotra ; MD ; MS¹ ; ²
• 关键词：End-stage renal disease (ESRD) ; hemodialysis ; peritoneal dialysis ; dialysis initiation ; all-cause mortality ; symptoms ; chronic kidney failure ; incident ESRD ; volume overload ; uremic symptoms ; hypertension ; indications for renal replacement therapy ; clinical decision making
• 刊名：American Journal of Kidney Diseases
• 出版年：2017
• 出版时间：January 2017
• 年：2017
• 卷：69
• 期：1
• 页码：41-50
• 全文大小：706 K
• 卷排序：69

文摘

Initiation of maintenance dialysis therapy for patients with chronic kidney failure is a period of high risk for adverse patient outcomes. Whether indications for dialysis therapy initiation are associated with mortality in this population is unknown.Study DesignRetrospective cohort study.Setting & Participants461 patients who initiated dialysis therapy (hemodialysis, 437; peritoneal dialysis, 24) from January 1, 2004, through December 31, 2012, and were treated in facilities operated by a single dialysis organization. Follow-up for the primary outcome was through December 31, 2013.PredictorClinically documented primary indication for dialysis therapy initiation, as categorized into 4 groups: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload or hypertension, and other/unknown.OutcomesAll-cause mortality.ResultsDuring a median follow-up of 2.4 years, 183 (40%) patients died. Crude mortality rates were 10.0 (95% CI, 6.8-14.7), 12.7 (95% CI, 10.2-15.7), 21.7 (95% CI, 16.4-28.6), and 12.2 (95% CI, 6.8-14.7) deaths/100 patient-years among patients initiating dialysis therapy primarily for laboratory evidence of kidney function decline, uremic symptoms, volume overload or hypertension, and other/unknown reason, respectively. Following adjustment for demographic variables, coexisting illnesses, and estimated glomerular filtration rate, initiation of dialysis therapy for uremic symptoms, volume overload or hypertension, or other/unknown reasons was associated with 1.12 (95% CI, 0.72-1.77), 1.69 (95% CI, 1.02-2.80), and 1.28 (95% CI, 0.73-2.26) times higher risk, respectively, for subsequent mortality compared to initiation for laboratory evidence of kidney function decline.LimitationsPossibility of residual confounding by unmeasured variables; reliance on clinical documentation to ascertain exposure.ConclusionsPatients initiating dialysis therapy due to volume overload may have increased risk for mortality compared with patients initiating dialysis due to laboratory evidence of kidney function decline. Further studies are needed to identify and test interventions that might reduce this risk.