Predialysis Management and Predictors for Early Mortality in Uremic Patients Who Die Within One Year After Initiation of Dialysis Therapy

Biesenbach, Georg; Hubmann, Rainer; Janko, O; Schmekal, Bernhard; Eichbauer-Sturm, Gabriela

doi:10.1081/jdi-120004096

Cited by 12 publications

(13 citation statements)

References 13 publications

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“…Studies that were conducted in non-population-based samples of incident patients have reported 90-d mortality rates ranging from 12 (20 -22) (2) were population based, minimizing concerns about selection bias, and both include relatively recent data from patients who initiated HD. The latter point may account for the lower mortality rates as compared with findings from earlier studies, potentially reflecting improvements in pre-ESRD treatment, including earlier referral to a nephrologist, which we and others (30,31) suggest improves survival once on dialysis. It is interesting that patients with diabetes were more likely than patients without diabetes (78.6 versus 72.6%; P Ͻ 0.0001) to receive predialysis care from a nephrologist, but this greater access to care did not seem to explain the unexpected lower 120-d mortality rate that was observed among patients with diabetes.…”

Section: Discussioncontrasting

confidence: 46%

Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Bradbury

Fissell

Albert

et al. 2007

Clinical Journal of the American Society of Nephrology

433

391

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Mortality risk among hemodialysis (HD) patients may be highest soon after initiation of HD. A period of elevated mortality risk was identified among US incident HD patients, and which patient characteristics predict death during this period and throughout the first year was examined using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996 through 2004). A retrospective cohort study design was used to identify mortality risk factors. All patient information was collected at enrollment. Life-table analyses and discrete logistic regression were used to identify a period of elevated mortality risk. Cox regression was used to estimate adjusted hazard ratios (HR) measuring associations between patient characteristics and mortality and to examine whether these associations changed during the first year of HD. (1), and a higher mortality rate within the first year after initiation of HD has been described (2). Identifying the period of highest risk for death after initiation of HD and factors that are associated with this higher risk are important to the care of patients who are new to HD (incident). Observational studies among prevalent HD patients have identified patient characteristics that are associated with greater mortality risk, including white race, older age, low serum albumin levels, low and elevated serum phosphorus levels, anemia, and cardiovascular disease (traditional risk factors) (3-14), as well as other nontraditional risk factors, including C-reactive protein and IL-6 levels (15,16). Studies also have supported the importance of early nephrology referral in the predialysis period for reducing mortality after HD initiation (17)(18)(19). Because these studies typically have included prevalent rather than incident patients, only limited information is available concerning mortality rates and factors that influence mortality immediately after HD initiation. One reason for this may be the 90-d Medicare entitlement period (coordination of benefits) during which coverage is not guaranteed (1). The few studies that have assessed mortality rates or risk predictors in the period immediately after HD initiation (2,20 -24) suggest an elevated mortality risk in the first 90 d, but it is unclear whether that elevation is limited to the first 90 d. One population-based study (2) found that 6% of HD patients died within the first 90 d, accounting for nearly 35% of deaths within the first year.Studies that quantify mortality rates and identify mortality predictors among incident HD populations are useful for understanding the influence of predialysis care and length of time on dialysis. Data from the 2004 Annual Dialysis Report (1) indicate higher mortality rates for patients who have received HD for Ͼ5 yr as compared with Ͻ2 yr, suggesting that length of time on HD modifies mortality risk. Most patients begin HD

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Section: Discussioncontrasting

confidence: 46%

Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Bradbury

Fissell

Albert

et al. 2007

Clinical Journal of the American Society of Nephrology

433

391

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“…32 Heart failure is the most common cause of early death in patients on dialysis. 33 So, end-stage renal disease patients do not die as often of myocardial infarctions, but rather from sudden cardiac death and congestive heart failure.…”

Section: Discussionmentioning

confidence: 99%

Frequency of Cardiovascular Risk Factors and Metabolic Syndrome in Patients with Chronic Kidney Disease

Sagun¹,

Kantarcı²,

Mesçi³

et al. 2010

Clinical Medicine & Research

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“…Surveillance data from the United States Renal Data System indicate that the first-year mortality rate has declined in recent years, though it remains elevated relative to later years [3]. To meaningfully reduce poor outcomes during the first year after dialysis initiation, patients must receive appropriate care before dialysis initiation; studies suggest that better care in the predialysis period improves outcomes after initiation, although a recent study raised doubt about the strength of that association [2,4,5,6,7,8]. …”

Section: Introductionmentioning

confidence: 99%

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

et al. 2014

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Background/Aims: Predialysis care has been associated with improved first-year outcomes. We investigated types of predialysis care associated with improved patient outcomes in patients initiating dialysis with a fistula and at least 2 years of predialysis care. Methods: In this retrospective cohort of incident hemodialysis patients with ≥2 years of Medicare coverage before dialysis initiation, care patterns and patients were determined using Medicare claims. Fistula use at initiation was ascertained from the Medical Evidence Report. Results: Patients aged ≥67 years who initiated hemodialysis with a fistula (n = 14,459) differed demographically and clinically from patients who initiated with other vascular access types; however, 55% had diabetes, 28% heart failure, and 40% ischemic heart disease. In the year preceding initiation, 88% of these patients visited a nephrologist, 66% a cardiologist, 9% an endocrinologist, and 3% a dietician; most underwent routine laboratory measurements. In the first year of dialysis, 50% were hospitalized and 1.3% underwent transplant; the mortality rate remained constant (∼20 per 100 patient-years). Of predialysis care factors evaluated, only fistula placement more than 1 month before dialysis initiation was associated with lower hospitalization and mortality risk and greater likelihood of transplant. Other potentially modifiable factors included more contact with cardiologists and endocrinologists. Conclusion: Patients initiating dialysis with a functioning fistula appear to receive substantial predialysis preparation. This selected population does not show the excess mortality risk often observed early in dialysis treatment. Earlier fistula placement and referral to cardiology and endocrinology appear to be important aspects of predialysis care.

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Predialysis Management and Predictors for Early Mortality in Uremic Patients Who Die Within One Year After Initiation of Dialysis Therapy

Cited by 12 publications

References 13 publications

Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Frequency of Cardiovascular Risk Factors and Metabolic Syndrome in Patients with Chronic Kidney Disease

Predialysis Care and Dialysis Outcomes in Hemodialysis Patients with a Functioning Fistula

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