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. 2018 May;50(5):963-971.
doi: 10.1007/s11255-018-1837-6. Epub 2018 Mar 12.

Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters

John J Sim  1 , Hui Zhou  2 , Jiaxiao Shi  2 , Sally F Shaw  2 , Shayna L Henry  2 , Csaba P Kovesdy  3 , Kamyar Kalantar-Zadeh  4 , Steven J Jacobsen  2
Affiliations

Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters

John J Sim et al. Int Urol Nephrol. 2018 May.

Erratum in

Abstract

Purpose: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD.

Methods: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed. Multivariable Cox regression modeling was used to estimate 6-month all-cause mortality hazard ratios (HR) among the three treatment groups after adjustment for patient and clinical characteristics.

Results: Among 5373 ESRD patients (62.7 years, 41.3% females, 37.5% Hispanics, 13.3% PD, 34.9% HD with fistula/graft, 51.8% HD with catheter), 551 (10.3%) died at 6 months. Mortality rates were highest immediately after transition (299 deaths per 1000 person-years in first month). Compared to PD patients, the 6-month mortality HR (95% CI) was 1.87 (1.06-3.30) in HD with fistula/graft patients and 3.77 (2.17-6.57) in HD with catheter patients. Inpatient transition (HR 1.32), acute kidney injury (HR 2.06), and an eGFR ≥ 15 vs 5-9 (HR 1.68) at transition were also associated with higher early mortality risk.

Conclusion: Among a diverse CKD population who transitioned to ESRD, we observed considerable differences in early mortality risk among PD, HD with fistula/graft, and HD with catheter patients. The identification of patient-specific and clinical environmental factors related to high early mortality may provide insights for managing advanced stages of CKD and shared decision making.

Keywords: Chronic kidney disease; Comparative outcomes; End-stage renal disease transition; Epidemiology; Mortality.

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Conflict of interest statement

None of the authors have any conflicts of interest relevant to this manuscript.

Figures

Figure 1
Figure 1
Among a total of 71,127 individuals (between 2002-2013) who were identified with CKD, 5,819 (8.2%) transitioned to ESRD. The study cohort was comprised of 5,373 CKD patients who transitioned to ESRD, had a documented eGFR within 90 days pretransition, and had an ESRD modality identified.
Figure 2
Figure 2
Monthly mortality rates up to 24 months of follow-up are reported in deaths per 100 person-years. a) Mortality rates for the entire ESRD transition population (N=5,373). b) Mortality rates for hemodialysis with catheter(HD-catheter), hemodialysis with AVF/AVG (HD-AVF/AVG) and peritoneal dialysis (PD) populations separately not including transplant. c) Mortality rates of the entire study cohort categorized by eGFR at transition (<5, 5-9, 10-14, and ≥15ml/min/1.73 m2). d Mortality rates of the entire study cohort categorized by age (<60, 60-69, 70-79, and ≥80).
See this image and copyright information in PMC

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