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. 2022 Jun 27;23(1):229.
doi: 10.1186/s12882-022-02852-1.

First-year mortality in incident dialysis patients: results of the Peridialysis study

James Heaf  1 , Maija Heiro  2 , Aivars Petersons  3 , Baiba Vernere  3 , Johan V Povlsen  4 , Anette Bagger Sørensen  4 , Naomi Clyne  5 , Inga Bumblyte  6 , Alanta Zilinskiene  6 , Else Randers  7 , Niels Løkkegaard  8 , Mai Rosenberg  9 , Stig Kjellevold  10 , Jan Dominik Kampmann  11 , Björn Rogland  12 , Inger Lagreid  13 , Olof Heimburger  14 , Abdul Rashid Qureshi  14 , Bengt Lindholm  14
Affiliations

First-year mortality in incident dialysis patients: results of the Peridialysis study

James Heaf et al. BMC Nephrol. .

Abstract

Background: Controversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI.

Methods: Among 1580 patients participating in the Peridialysis study, a study of causes and timing of DI, we registered features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice. Patients were followed for 12 months or until transplantation. A flexible parametric model was used to identify independent factors associated with all-cause mortality.

Results: First-year mortality was 19.33%. Independent factors predicting death were high age, comorbidity, clinical contraindications to PD or HD, suboptimal DI, high eGFR, low serum albumin, hyperphosphatemia, high C-reactive protein, signs of overhydration and cerebral symptoms at DI. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD.

Conclusions: First-year mortality in incident dialysis patients was in addition to high age and comorbidity, associated with clinical contraindications to PD or HD, clinical symptoms, hyperphosphatemia, inflammation, and suboptimal DI. In patients with a "free" choice of dialysis modality based on their personal preferences, PD and in-center HD led to broadly similar short-term outcomes.

Keywords: Hemodialysis; Mortality; Peritoneal dialysis; Survival analysis.

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Conflict of interest statement

Bengt Lindholm is employed by Baxter Healthcare at Baxter Novum, Karolinska Institutet. None of the other authors declare any conflicts of interest.

Figures

Fig. 1
Fig. 1
Kaplan Meier curves showing relationship of initial dialysis treatment (in-centre HD or PD) with first year all-cause mortality among 1580 patients starting on dialysis
Fig. 2
Fig. 2
Kaplan Meier curves showing relationship of initial dialysis treatment with first year all-cause mortality among 1580 patients starting dialysis
Fig. 3
Fig. 3
Kaplan Meier curves showing relationship between first year all-cause mortality and cause of initial modality choice among 1580 patients starting dialysis. At one year, mortality was highest (> 50%) among patients with Physical PD contraindication (n = 71) and patients with Other contraindications (n = 142); intermediary high (20–30%) for the categories PD not offered (n = 106), Mental PD contraindication (n = 80) and HD not possible (n = 46); and, lowest (15–20%) for patients with “free choice” of PD (n = 654) or HD (n = 368) and patients with Abdominal PD contraindication (n = 113)
Fig. 4
Fig. 4
Forest plot showing significant associations of factors with first-year all-cause mortality risk among 1580 patients starting dialysis in three separate models and a combined model including factors with significant associations to mortality in the three separate models. Survival was analysed by a flexible parametric model with stpm2 command. Results are expressed as hazard ratios for all-cause mortality with 95% confidence interval. All models were adjusted for age, sex, renal diagnosis, and presence of comorbidity. For cause of choice, reference was "HD free choice"
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References

    1. Heaf J. Current trends in European renal epidemiology. Clin Kidney J. 2017;10(2):149–153. - PMC - PubMed
    1. Pippias M, Jager KJ, Kramer A, Leivestad T, Sanchez MB, Caskey FJ, Collart F, Couchoud C, Dekker FW, Finne P, et al. The changing trends and outcomes in renal replacement therapy: data from the ERA-EDTA Registry. Nephrol Dial Transplant. 2016;31(5):831–841. - PubMed
    1. Saran R, Robinson B, Abbott KC, Bragg-Gresham J, Chen X, Gipson D, Gu H, Hirth RA, Hutton D, Jin Y, et al. US Renal Data System 2019 Annual Data Report: Epidemiology of Kidney Disease in the United States. Am J Kidney Dis. 2020;75(1 Suppl 1):A6–A7. - PubMed
    1. van Walraven C, Manuel DG, Knoll G. Survival trends in ESRD patients compared with the general population in the United States. Am J Kidney Dis. 2014;63(3):491–499. - PubMed
    1. McIntyre CW, Rosansky SJ. Starting dialysis is dangerous: how do we balance the risk? Kidney Int. 2012;82(4):382–387. - PubMed

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