Vascular Disease, ESRD, and Death

Abstract

SummaryBackground and objectives Vascular disease, a common condition in CKD, is a risk factor for mortality and ESRD. Optimal patient care requires accurate estimation and ordering of these competing risks.Design, setting, participants, & measurements This is a prospective cohort study of screened (n=885) and randomized participants (n=837) in the Modification of Diet in Renal Disease study (original study enrollment, 1989-1992), evaluating the association of vascular disease with ESRD and pre-ESRD mortality using standard survival analysis and competing risk regression.Results The method of analysis resulted in markedly different estimates. Cumulative incidence by standard analysis (censoring at the competing event) implied that, with vascular disease, the 15-year incidence was 66% and 51% for ESRD and pre-ESRD death, respectively. A more accurate representation of absolute risk was estimated with competing risk regression: 15-year incidence was 54% and 29% for ESRD and pre-ESRD death, respectively. For the association of vascular disease with pre-ESRD death, estimates of relative risk by the two methods were similar (standard survival analysis adjusted hazard ratio, 1.63; 95% confidence interval, 1.20-2.20; competing risk regression adjusted subhazard ratio, 1.57; 95% confidence interval, 1.15-2.14). In contrast, the hazard and subhazard ratios differed substantially for other associations, such as GFR and pre-ESRD mortality.Conclusions When competing events exist, absolute risk is better estimated using competing risk regression, but etiologic associations by this method must be carefully interpreted. The presence of vascular disease in CKD decreases the likelihood of survival to ESRD, independent of age and other risk factors.

Past Decline Versus Current eGFR and Subsequent ESRD Risk

“…In sensitivity analyses, we applied the adjusted sub-HRs from competing risk models accounting for death as a competing end point. 34 In additional sensitivity analyses, we examined the association between eGFR slopes and ESRD in subgroups of patients divided by exposure to RAAS inhibitor medications during the slope evaluation period. Analyses were performed using Stata/SE 12 software (StataCorp., College Station, TX; www.stata.com).…”

Risk Factors For Unplanned Readmission In Older Adult Trauma Patients In Our Institute

“…Other studies have similarly suggests ISS has been an inconsistent predictor of longer-term outcomes after trauma 2,29 . On the other hand, the apparent "protective" effect of increasing ISS can be seen in a population where number of patients experiencing the competing event is high 20,21 . This is understood by examining the reverse competing risk model of death without readmission.…”

“…This is understood by examining the reverse competing risk model of death without readmission. Patients with high ISS scores were at increased risk of out hospital death, possibly eliminating any increased risk of readmission from a statistical point of view 21 .…”

“…But, in present study populations where death is comparatively common, it is more appropriately dealt as a competing event (one that precludes future results of interest). Studies have presented that in cases in which standard survival analysis is used and competing events are not treated suitably from a statistical stance, risk of the results of interest can be meaningfully overestimated 21 .…”

“…However surgical patients (including trauma patients) have not received the same level of attention 16,17,18 . We undertook this study with aims to determine the unplanned admissions after hospitalisations for trauma and 21 . At the time of index hospitalisation following variables are determined.…”