Association of early initiation of dialysis with all‐cause and cardiovascular mortality: A propensity score weighted analysis of the United States Renal Data System

Bozorgmehri, Shahab; Aboud, Hussain; Chamarthi, Gajapathiraju; Liu, I-Chia; Ozrazgat‐Baslanti, Tezcan; Shukla, Ashutosh; Kazory, Amir; Ruchi, Rupam; Segal, Mark S.; Mohandas, Rajesh

doi:10.1111/hdi.12912

Cited by 3 publications

(2 citation statements)

References 23 publications

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“…Previous observational studies that attempted to investigate multiple estimated glomerular filtration rate (eGFR) strategies have been limited by insufficient power, 11 12 13 immortal time bias, 14 15 16 17 or lead time and selection biases. 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 In 2010 the Initiating Dialysis Early and Late (IDEAL) trial showed that a strategy to start dialysis at an eGFR of 10-14 mL/min/1.73 m 2 was not superior to one of waiting until symptoms develop or eGFR is 5-7 mL/min/1.73 m 2 . 33 This is reflected in subsequent guidelines, which recommend starting dialysis when symptoms and signs attributable to kidney failure arise rather than at a specific kidney function.…”

Section: Introductionmentioning

confidence: 99%

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study

Evans

Carrero

et al. 2021

BMJ

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Objective To identify the optimal estimated glomerular filtration rate (eGFR) at which to initiate dialysis in people with advanced chronic kidney disease. Design Nationwide observational cohort study. Setting National Swedish Renal Registry of patients referred to nephrologists. Participants Patients had a baseline eGFR between 10 and 20 mL/min/1.73 m 2 and were included between 1 January 2007 and 31 December 2016, with follow-up until 1 June 2017. Main outcome measures The strict design criteria of a clinical trial were mimicked by using the cloning, censoring, and weighting method to eliminate immortal time bias, lead time bias, and survivor bias. A dynamic marginal structural model was used to estimate adjusted hazard ratios and absolute risks for five year all cause mortality and major adverse cardiovascular events (composite of cardiovascular death, non-fatal myocardial infarction, or non-fatal stroke) for 15 dialysis initiation strategies with eGFR values between 4 and 19 mL/min/1.73 m 2 in increments of 1 mL/min/1.73 m 2 . An eGFR between 6 and 7 mL/min/1.73 m 2 (eGFR 6-7 ) was taken as the reference. Results Among 10 290 incident patients with advanced chronic kidney disease (median age 73 years; 3739 (36%) women; median eGFR 16.8 mL/min/1.73 m 2 ), 3822 started dialysis, 4160 died, and 2446 had a major adverse cardiovascular event. A parabolic relation was observed for mortality, with the lowest risk for eGFR 15-16 . Compared with dialysis initiation at eGFR 6-7 , initiation at eGFR 15-16 was associated with a 5.1% (95% confidence interval 2.5% to 6.9%) lower absolute five year mortality risk and 2.9% (0.2% to 5.5%) lower risk of a major adverse cardiovascular event, corresponding to hazard ratios of 0.89 (95% confidence interval 0.87 to 0.92) and 0.94 (0.91 to 0.98), respectively. This 5.1% absolute risk difference corresponded to a mean postponement of death of 1.6 months over five years of follow-up. However, dialysis would need to be started four years earlier. When emulating the intended strategies of the Initiating Dialysis Early and Late (IDEAL) trial (eGFR 10-14 v eGFR 5-7 ) and the achieved eGFRs in IDEAL (eGFR 7-10 v eGFR 5-7 ), hazard ratios for all cause mortality were 0.96 (0.94 to 0.99) and 0.97 (0.94 to 1.00), respectively, which are congruent with the findings of the randomised IDEAL trial. Conclusions Very early initiation of dialysis was associated with a modest reduction in mortality and cardiovascular events. For most patients, such a reduction may not outweigh the burden of a substantially longer period spent on dialysis.

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Section: Introductionmentioning

confidence: 99%

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study

Evans

Carrero

et al. 2021

BMJ

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“…Despite this, patients started dialysis in 2013 and 2018 at a median eGFR of 9 ml/min/1.73 m 2 , with the upper 25th percentile starting dialysis at a median of 12 ml/min/1.73 m 2 . More recently, a study by Bozorgmehri [25 ▪▪ ] showed that early initiation of dialysis was associated with an increased all-cause and cardiovascular mortality.…”

Section: Early Initiation Of Hemodialysismentioning

confidence: 99%

Factors that lead to dialysis as the preferred treatment modality for patients with chronic kidney disease

Bleyer¹

2021

Current Opinion in Nephrology &Amp; Hypertension

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Purpose of reviewTo describe forces that lead to dialysis as the preferred treatment modality for patients with chronic kidney disease. Recent findingsAlthough chronic dialysis is life-saving and the only option available for many individuals, treatment of the underlying causes of kidney disease and transplantation may be preferable options for many patients. Factors that favor dialysis instead of treatment of underlying kidney disease or transplantation include lack of proper diagnosis, lack of proper treatment of underlying kidney disease, poor compliance, lack of consideration for transplantation, early initiation of dialysis therapy, and financial incentives. New developments that may reverse this trend include genetic panels that improve diagnosis of kidney disease, new methods of transplantation, and legislation that will encourage kidney transplantation.

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The Etiology of Kidney Failure in Indonesia: A Multicenter Study in Tertiary-Care Centers in Jakarta

Hustrini,

Susalit,

Lydia

et al. 2023

agh

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Background: Despite a large number of patients requiring dialysis, the etiology of kidney failure is poorly documented in Indonesia. With the aim to reduce the disease burden, it is essential to obtain more insight in the etiology of chronic kidney disease (CKD). Objective(s): In the present study, we attempted to investigate the primary renal disease of kidney failure patients from five tertiary-care centers in Jakarta. Methods: This is a multicenter, cross-sectional study of kidney failure patients receiving kidney replacement therapy (KRT), from December 2021 to July 2022. We recruited patients aged ≥18 years, had been receiving dialysis for at least three months or a kidney transplantation. Findings: This study included 1,152 patients treated with hemodialysis (68.1%), peritoneal dialysis (7.5%), and kidney transplantation (24.4%). At the start of KRT, the median (interquartile-range [IQR]) age was 48 [37–58] years with low eGFR (median [IQR]: 5.9 [4.0–8.34] ml/minute/1.73 m2). Hypertension was the main comorbidity (74.2%), followed by diabetes mellitus (30.1%). The major primary kidney disease was diabetic kidney disease (27.2%), followed by glomerulonephritis (13.0%), hypertension (11.5%), and urolithiasis (10.3%). Lupus nephritis was the common underlying etiology of secondary glomerulonephritis (91%). A high rate of unknown cause (31.1%) was also observed. Conclusions: Our results suggest that diabetic kidney disease is the leading cause of kidney failure in Jakarta, followed by glomerulonephritis. This study highlights the need for a better approach on primary prevention of diabetes mellitus as well as to better recognize glomerulonephritis at earlier stage might have a significant impact on reduction of the rate of kidney failure in Indonesia.

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Association of early initiation of dialysis with all‐cause and cardiovascular mortality: A propensity score weighted analysis of the United States Renal Data System

Cited by 3 publications

References 23 publications

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study

Timing of dialysis initiation to reduce mortality and cardiovascular events in advanced chronic kidney disease: nationwide cohort study

Factors that lead to dialysis as the preferred treatment modality for patients with chronic kidney disease

The Etiology of Kidney Failure in Indonesia: A Multicenter Study in Tertiary-Care Centers in Jakarta

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