The State of Chronic Kidney Disease, ESRD, and Morbidity and Mortality in the First Year of Dialysis

Collins, Allan J.; Foley, Robert N.; Gilbertson, David T.; Chen, Shu-Chen

doi:10.2215/cjn.05980809

Cited by 258 publications

(238 citation statements)

References 2 publications

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“…Mortality rates once a patient has been initiated on chronic dialysis have fallen over the years but have remained quite elevated at approximately 250 per 1000 patient years for those in their first year of dialysis. 88 Mortality rates amongst those with CKD in the absence of ESRD have been reported at approximately 160 per 1000 patient-years, whereas death rates for those without CKD range from 50-100 per 1000 patient-years. 89 These patients also suffer from complications and hospitalizations related to increased cardiac morbidity and infection rates.…”

Section: Limitations In the Literaturementioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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The surgical management of renal masses involves either radical nephrectomy (RN) or partial nephrectomy (PN). PN has been associated with better long-term renal function, and has also been linked to improved cardiac morbidity and overall survival. However, the relationship between treatment choice and definitive outcomes of chronic kidney disease (CKD) are lacking. Our aim was to examine whether PN is associated with a lower risk of end-stage renal disease (ESRD) requiring renal replacement therapy.We performed a population-based, retrospective cohort study with data from linked administrative databases in the province of Ontario, Canada. We included individuals with pathologically confirmed renal cell carcinoma (RCC) diagnosed between 1995 and 2010. Cox proportional hazards (PH) models, propensity score models, and competing risks models were used to assess the impact of treatment choice. PN compared to RN reduces the risk of ESRD requiring renal replacement therapy in a modern cohort of patients (2003)(2004)(2005)(2006)(2007)(2008)(2009)(2010). PN is associated with a lower risk of new-onset CKD, lower risk of cardiac morbidity, and improved overall survival. We provide further evidence for the benefit of PN compared to RN, particularly related to definitive outcomes of renal failure.iii ACKNOWLEDGEMENTS

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Section: Limitations In the Literaturementioning

confidence: 99%

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Yap¹,

Alibhai²,

Tomlinson³

et al. 2013

European Urology Supplements

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“…The prevalence of end-stage renal disease (ESRD) is increasing, with the population of the affected individuals in the USA almost doubling every 10 years (1). ESRD has now become a major health problem worldwide.…”

Section: Introductionmentioning

confidence: 99%

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Shi

Huang

et al. 2016

Molecular and Clinical Oncology

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Abstract. It has been reported that patients receiving renal replacement therapy (RRT), including dialysis and kidney transplantation, tend to have an increased risk of cancer; however, studies on the degree of this risk have remained inconclusive. The present meta-analysis was therefore performed to quantify the cancer risk in patients with RRT. Cohort studies assessing overall cancer risk in RRT patients published before May 29, 2015 were included following systematic searches with of PubMed, EMBASE and the reference lists of the studies retrieved. Random-effects meta-analyses were used to pool standardized incidence rates (SIRs) with 95% confidence intervals (CIs). Heterogeneity tests, sensitivity analyses and publication bias assessment were performed. A total of 18 studies including 22 cohort studies were eventually identified, which comprised a total of 1,528,719 patients. In comparison with the general population, the pooled SIR for patients with dialysis including non-melanoma skin cancer (NMSC), dialysis excluding NMSC, transplantation including NMSC, transplantation excluding NMSC and RRT were 1.40 (95% CI, 1.36-1.45), 1.35 (95% CI, 1.23-1.50), 3.26 (95% CI, 2.29-4.63), 2.08 (95% CI, 1.73-2.50) and 2.01 (95% CI, 1.70-2.38), respectively. The cancer risk was particularly high in subgroups of large sample size trials, female patients, younger patients (age at first dialysis, 0-34 years; age at transplantation, 0-20 years), the first year of RRT and non-Asian transplant patients. A significant association was also found between RRT and the majority of organ-specific cancers. However, neither dialysis nor transplantation was associated with breast, body of uterus, colorectal or prostate cancer. Significant heterogeneity was found regarding the association between RRT and overall cancer as well as the majority of site-specific cancer types. However, this heterogeneity had no substantial influence on the pooled SIR for overall cancer in RRT according to the sensitivity analysis. Compared with the general population, RRT patients have a significantly increased risk of overall cancer and the majority of specific cancer types, particularly Kaposi sarcoma (KS), lip cancer and NMSC in patients subjected to kidney transplantation and cancer of the thyroid gland and kidney as well as myeloma in dialysis patients. Considering the high heterogeneity encountered, further high-quality studies are required.

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“…Nearly 80% of United States patients initiate hemodialysis with a central venous catheter rather than a permanent vascular access (1), placing these patients at an increased risk of infection, hospitalization, morbidity, and mortality (1)(2)(3)(4)(5)(6). Substantial efforts have been undertaken by nephrologists to increase the use of permanent vascular access at hemodialysis initiation, specifically arteriovenous fistulas (AVFs).…”

Section: Introductionmentioning

confidence: 99%

Predictors of Initiation for Predialysis Arteriovenous Fistula

Al-Balas¹,

Lee

Young

et al. 2016

CJASN

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Background and objectives The optimal timing of predialysis arteriovenous fistula surgery remains uncertain. We evaluated factors associated with hemodialysis initiation in patients undergoing predialysis arteriovenous fistula surgery and derived a model to predict future initiation of dialysis.Design, setting, participants, & measurements Our study retrospectively identified 308 patients undergoing predialysis arteriovenous fistula creation at a large medical center in 2006-2012 to determine whether they initiated hemodialysis. Multiple variable logistic regression analyzed which demographic and clinical factors predicted initiation of dialysis within 2 years of arteriovenous fistula surgery. A receiver operating characteristic area under the curve was used to quantify the predictive value of preoperative factors on the likelihood of initiating hemodialysis within 2 years.Results Overall, hemodialysis was initiated within 6 months, 1 year, and 2 years in 119 (39%), 175 (57%), and 211 (68%) patients, respectively. Using multiple variable logistic regression, four factors were associated with hemodialysis initiation at 2 years: eGFR at access surgery (odds ratio, 0.45; 95% confidence interval, 0.31 to 0.64 per 5 ml/min per 1.73 m 2 ; P,0.001), diabetes (odds ratio, 2.51; 95% confidence interval, 1.22 to 5.15; P=0.003), GFR trajectory (odds ratio, 1.54; 95% confidence interval, 1.09 to 2.17 per 3 ml/min per 1.73 m 2 per year; P=0.01), and spot urine protein-to-creatinine ratio (odds ratio, 1.39; 95% confidence interval, 1.14 to 1.71 per 1 U; P,0.001). eGFR alone had a moderate predictive value for dialysis initiation (area under the curve =0.69; 95% confidence interval, 0.63 to 0.76; P,0.001), whereas the full model had a higher predictive value (area under the curve =0.83; 95% confidence interval, 0.77 to 0.88; P,0.001).Conclusions The likelihood of initiating hemodialysis within 2 years of predialysis arteriovenous fistula surgery is associated with eGFR at access surgery, diabetes, GFR trajectory, and magnitude of proteinuria. The combined use of all four variables improves the ability to predict future hemodialysis compared with the use of eGFR alone.

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The State of Chronic Kidney Disease, ESRD, and Morbidity and Mortality in the First Year of Dialysis

Cited by 258 publications

References 2 publications

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

886 Partial nephrectomy for the treatment of renal cell carcinoma and the risk of end stage renal disease

Cancer risk in patients receiving renal replacement therapy: A meta-analysis of cohort studies

Predictors of Initiation for Predialysis Arteriovenous Fistula

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