Survival and transplantation in end-stage renal disease: a prospective study of a multiethnic population

Abstract

Survival was 29% after a mean and median follow up of 4.6 and 4.2 years, respectively. Factors associated with worse survival included the following: age; for each decade of life the relative risk (RR) of death was 1.52 (95% confidence intervals 1.41-1.65, p < 0.0001); comorbidity, one or two comorbid conditions, RR = 1.56 (95% CI 1.24-1.95, p < 0.001) and three or more comorbid conditions, RR = 2.34 (1.68-3.27, p < 0.001). Factors associated with better survival included the following: south-Asian ethnicity, RR = 0.6 (0.46-0.80, p < 0.001); renal transplantation, RR = 0.20 (95% CI 0.11-0.59, p < 0.0001) and glomerulonephritis as the primary renal disease, RR = 0.70 (0.50-0.97, p = 0.04). Factors associated with likelihood of transplantion were having a functioning fistula/peritoneal dialysis catheter at start of dialysis (RR 1.91, 95% CI 1.24-2.94, p = 0.003) and glomerulonephritis (RR 9.54, 95% CI 2.43-37.64, p = 0.001). Patients were less likely to receive if they were black (RR 0.10, 95% CI 0.02-0.34, p < 0.001), South Asian (RR 0.64, 95% CI 0.42-0.97, p = 0.037), diabetic (RR 0.06, 95% CI 0.01-0.23, p < 0.001) and had one or two comorbid conditions (RR 0.51, 95% CI 0.32-0.82, p = 0.06). Every decade increase in age was also associated with a lesser likelihood of transplantation (RR 0.55, 95% CI 0.49-0.61, p < 0.001). Discussion. Risk stratification at commencement of chronic dialysis may predict long-term survival in different patient groups. As expected ethnic minorities are less likely to receive a transplant and this should be addressed by the new waiting list prioritization. The better survival on dialysis in this population of patients with south-Asian ethnicity is unexplained and this requires further investigation.

Systematic Review: Kidney Transplantation Compared With Dialysis in Clinically Relevant Outcomes

“…Unfortunately, these data were reported very infrequently and so are not reported here. Characteristics that were explored by the included studies as potential determinants of the benefit of transplantation were hepatitis B and/or hepatitis C virus serostatus of the recipient (13,14) and donor (15), extended‐criteria donor (16,17), primary cause of ESRD (18–23), findings of coronary angiography (24,25), coronary artery bypass surgery (26), a low‐protein diet (27), cancer (28), diabetes (22,29–34), obesity (35), employment (36), race (37–42) and age (7,43–47).…”

Should We STOP Angiotensin Converting Enzyme Inhibitors/Angiotensin Receptor Blockers in Advanced Kidney Disease?

“…CVD accounted for 41% of all deaths. Kidney transplantation is associated with better clinical outcomes and quality of life but remains a scarce commodity and is not an option for many dialysis patients in whom associated co-morbidity precludes transplantation [19]. In this population, dialysis avoidance has to be balanced against cardiovascular risk.…”

“…This was in patients with CKD stage 4 or better. The presence of CKD has a major negative impact on a range of other outcomes including quality of life [19,25] and is a predictor of increased cardiovascular mortality in CKD [34]. …”

“…Lowering BP reduces cardiovascular events but evidence suggests that ACEi/ARBs are not superior to other antihypertensive agents [15,16]. Studies in dialysis patients have shown variable effects on cardiovascular events with use of ACEi [17,18], while the rate of decline of renal function remains a strong predictor of mortality [19,20,21,22]. …”

The natural history of, and risk factors for, progressive Chronic Kidney Disease (CKD): the Renal Impairment in Secondary care (RIISC) study; rationale and protocol

“…Those at highest risk from progressive CKD have an accelerated deterioration of kidney function, significant albuminuria, and/or more advanced CKD at inception [8,9]. The large majority of people with CKD die before they reach end-stage kidney disease (ESKD) and have an increased risk of cardiovascular disease (CVD) that is directly related to the severity of their kidney disease [10,11]. …”