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Premprasong A, Nata N, Tangwonglert T, Supasyndh O, Satirapoj B. Risk factors associated with mortality among patients on maintenance hemodialysis: The Thailand Renal Replacement Therapy registry. Ther Apher Dial 2024. [PMID: 38803037 DOI: 10.1111/1744-9987.14166] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/06/2024] [Revised: 05/05/2024] [Accepted: 05/14/2024] [Indexed: 05/29/2024]
Abstract
INTRODUCTION End-stage kidney disease (ESKD) has been increasing in prevalence across the world, including Thailand, and patients with ESKD on hemodialysis have a high mortality risk. METHODS A retrospective cohort study was performed across 855 hemodialysis centers in the Thailand Renal Replacement Therapy registry. The database and mortality data were analyzed. RESULTS A total of 58 952 patients were included. The survival rates at 1, 3, and 5 years were 93.5%, 69.7%, and 41.2%, respectively. On multivariate analysis, factors such as aging, permanent catheter or arteriovenous graft, twice-weekly hemodialysis, low levels of urea reduction ratio, normalized protein catabolic rate, hemoglobin, transferrin saturation, serum albumin, LDL-cholesterol, intact-parathyroid hormone, uric acid, sodium, phosphate, and bicarbonate were significantly related to death. CONCLUSION Mortality is high in ESKD patients on hemodialysis. Age, type of vascular access, twice-weekly hemodialysis, inadequate dialysis, low protein intake, anemia, abnormal electrolytes, and bone mineral disorders are associated with all-cause mortality.
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Affiliation(s)
- Artchawin Premprasong
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Naowanit Nata
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Theerasak Tangwonglert
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Ouppatham Supasyndh
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
| | - Bancha Satirapoj
- Division of Nephrology, Department of Medicine, Phramongkutklao Hospital and College of Medicine, Bangkok, Thailand
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Wong YHS, Wong G, Johnson DW, McDonald S, Clayton P, Boudville N, Viecelli AK, Lok C, Pilmore H, Hawley C, Roberts MA, Walker R, Ooi E, Polkinghorne KR, Lim WH. Socioeconomic disparity, access to care and patient relevant outcomes after kidney allograft failure. Transpl Int 2021; 34:2329-2340. [PMID: 34339557 DOI: 10.1111/tri.14002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/17/2020] [Revised: 06/16/2021] [Accepted: 07/11/2021] [Indexed: 11/28/2022]
Abstract
Social disparity is a major impediment to optimal health outcomes after kidney transplantation. In this study, we aimed to define the association between socioeconomic status (SES) disparities and patient-relevant outcomes after kidney allograft failure. Using data from the Australia and New Zealand Dialysis and Transplant registry, we included patients with failed first kidney allografts in Australia between 2005-2017. The association between residential postcode-derived SES in quintiles (quintile 1-most disadvantaged areas, quintile 5-most advantaged areas) with uptake of home dialysis (peritoneal or home haemodialysis) within the first 12-months post-allograft failure, repeat transplantation and death on dialysis were examined using competing-risk analysis. Of 2175 patients who had experienced first allograft failure, 417(19%) and 505(23%) patients were of SES quintiles 1 and 5, respectively. Compared to patients of quintile 5, quintile 1 patients were less likely to receive repeat transplants (adjusted subdistributional hazard ratio [SHR] 0.70,95%CI 0.55-0.89) and were more likely to die on dialysis (1.37[1.04-1.81]), but there was no association with the uptake of home dialysis (1.02[0.77-1.35]). Low SES may have a negative effect on outcomes post-allograft failure and further research is required into how best to mitigate this. However, small-scale variation within SES cannot be accounted for in this study.
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Affiliation(s)
- Yun Hui Sheryl Wong
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia
| | - Germaine Wong
- University of Sydney, Sydney, Australia.,Centre for Kidney Research, The Children's Hospital at Westmead, Sydney, Australia.,Department of Renal Medicine and National Pancreas Transplant Unit, Westmead Hospital, Sydney, Australia
| | - David W Johnson
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Stephen McDonald
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, Australia.,University of Adelaide, Adelaide, Australia.,Royal Adelaide Hospital, Adelaide, Australia
| | - Philip Clayton
- South Australian Health and Medical Research Institute, ANZDATA Registry, Adelaide, Australia.,University of Adelaide, Adelaide, Australia.,Royal Adelaide Hospital, Adelaide, Australia
| | - Neil Boudville
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
| | - Andrea K Viecelli
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia
| | - Charmaine Lok
- Division of Nephrology, Department of Medicine, University Health Network-Toronto General Hospital, Toronto, Canada.,The University of Toronto, Toronto, Canada
| | - Helen Pilmore
- Department of Renal Medicine, Auckland City Hospital, Auckland, New Zealand.,Department of Medicine, Auckland University, Auckland, New Zealand
| | - Carmel Hawley
- Department of Nephrology, Princess Alexandra Hospital, Queensland, Australia.,University of Queensland, Queensland, Australia.,Translational Research Institute, Brisbane, Australia
| | - Matthew A Roberts
- Eastern Health Clinical School, Monash University, Victoria, Australia
| | | | - Esther Ooi
- Medical School, University of Western Australia, Perth, Australia.,School of Biomedical Sciences, University of Western Australia, Perth, Australia
| | - Kevan R Polkinghorne
- Department of Nephrology, Monash Medical Centre, Victoria, Australia.,Department of Medicine, Monash University, Victoria, Australia.,Department of Epidemiology and Preventive Medicine, Monash University, Victoria, Australia
| | - Wai H Lim
- Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.,Medical School, University of Western Australia, Perth, Australia
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Hall PS, Mitchell ED, Smith AF, Cairns DA, Messenger M, Hutchinson M, Wright J, Vinall-Collier K, Corps C, Hamilton P, Meads D, Lewington A. The future for diagnostic tests of acute kidney injury in critical care: evidence synthesis, care pathway analysis and research prioritisation. Health Technol Assess 2019; 22:1-274. [PMID: 29862965 DOI: 10.3310/hta22320] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022] Open
Abstract
BACKGROUND Acute kidney injury (AKI) is highly prevalent in hospital inpatient populations, leading to significant mortality and morbidity, reduced quality of life and high short- and long-term health-care costs for the NHS. New diagnostic tests may offer an earlier diagnosis or improved care, but evidence of benefit to patients and of value to the NHS is required before national adoption. OBJECTIVES To evaluate the potential for AKI in vitro diagnostic tests to enhance the NHS care of patients admitted to the intensive care unit (ICU) and identify an efficient supporting research strategy. DATA SOURCES We searched ClinicalTrials.gov, The Cochrane Library databases, Embase, Health Management Information Consortium, International Clinical Trials Registry Platform, MEDLINE, metaRegister of Current Controlled Trials, PubMed and Web of Science databases from their inception dates until September 2014 (review 1), November 2015 (review 2) and July 2015 (economic model). Details of databases used for each review and coverage dates are listed in the main report. REVIEW METHODS The AKI-Diagnostics project included horizon scanning, systematic reviewing, meta-analysis of sensitivity and specificity, appraisal of analytical validity, care pathway analysis, model-based lifetime economic evaluation from a UK NHS perspective and value of information (VOI) analysis. RESULTS The horizon-scanning search identified 152 potential tests and biomarkers. Three tests, Nephrocheck® (Astute Medical, Inc., San Diego, CA, USA), NGAL and cystatin C, were subjected to detailed review. The meta-analysis was limited by variable reporting standards, study quality and heterogeneity, but sensitivity was between 0.54 and 0.92 and specificity was between 0.49 and 0.95 depending on the test. A bespoke critical appraisal framework demonstrated that analytical validity was also poorly reported in many instances. In the economic model the incremental cost-effectiveness ratios ranged from £11,476 to £19,324 per quality-adjusted life-year (QALY), with a probability of cost-effectiveness between 48% and 54% when tests were compared with current standard care. LIMITATIONS The major limitation in the evidence on tests was the heterogeneity between studies in the definitions of AKI and the timing of testing. CONCLUSIONS Diagnostic tests for AKI in the ICU offer the potential to improve patient care and add value to the NHS, but cost-effectiveness remains highly uncertain. Further research should focus on the mechanisms by which a new test might change current care processes in the ICU and the subsequent cost and QALY implications. The VOI analysis suggested that further observational research to better define the prevalence of AKI developing in the ICU would be worthwhile. A formal randomised controlled trial of biomarker use linked to a standardised AKI care pathway is necessary to provide definitive evidence on whether or not adoption of tests by the NHS would be of value. STUDY REGISTRATION The systematic review within this study is registered as PROSPERO CRD42014013919. FUNDING The National Institute for Health Research Health Technology Assessment programme.
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Affiliation(s)
- Peter S Hall
- Edinburgh Cancer Research Centre, University of Edinburgh, Edinburgh, UK
| | | | - Alison F Smith
- Academy of Primary Care, Hull York Medical School, Hull, UK.,National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | - David A Cairns
- Leeds Institute of Clinical Trials Research, University of Leeds, Leeds, UK
| | - Michael Messenger
- National Institute for Health Research (NIHR) Diagnostic Evidence Co-operative Leeds, Leeds, UK
| | | | - Judy Wright
- Academy of Primary Care, Hull York Medical School, Hull, UK
| | | | | | - Patrick Hamilton
- Manchester Institute of Nephrology and Transplantation, Central Manchester University Hospitals NHS Foundation Trust, Manchester, UK
| | - David Meads
- Academy of Primary Care, Hull York Medical School, Hull, UK
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Wu HC, Tseng SF, Wang WJ, Chen HJ, Lee LC. Association between obesity with low muscle mass and dialysis mortality. Intern Med J 2018; 47:1282-1291. [PMID: 28742229 DOI: 10.1111/imj.13553] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/18/2016] [Revised: 06/20/2017] [Accepted: 07/18/2017] [Indexed: 01/06/2023]
Abstract
BACKGROUND/AIM To examine the association between body composition and dialysis mortality. METHODS Adult patients who underwent haemodialysis in Taoyuan General Hospital from 2012 to 2016 were enrolled. We reviewed their baseline characteristics and followed up their treatment over 5 years after dialysis. Patients with body mass index >25 kg/m2 were defined as obese. High or low muscle mass were classified by skeletal muscle mass index (SMMI) based on consensus from Chinese population. All age-matched subjects were classified into four groups: (A) optimal; (B) obesity; (C) low muscle mass; and (D) obesity with low muscle mass. Adjusted hazard ratios for mortality and cumulative survival curves were evaluated by Cox proportional hazard model and Kaplan-Meier method. The discriminative power of SMMI was calculated according to the area under the curve and the receiver operating characteristic curve. RESULTS From a total of 176 age-matched patients, the incidence rates of mortality for different groups were 3.7, 7.8, 10.3 and 16.5 per 1000 person-months. After adjusting for continuous variables, SMMI was independently associated with mortality. The difference between groups A and D was more significant in women than in men after multivariate adjustment (adjusted hazard ratios: 7.465 vs 1.682) (P = 0.035 and 0.553). The discriminative power of SMMI to predict 5-year mortality was 0.700 for men and 0.750 for women, and the best cut-off values were 11.1 and 8.4 kg/m2 CONCLUSIONS: Low muscle mass was associated with dialysis mortality. Obesity with low muscle mass was a predictor for dialysis mortality in women.
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Affiliation(s)
- Hung-Chieh Wu
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Ministry of Health and Welfare, Taoyuan, Taiwan.,Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Shih-Fen Tseng
- Department of Emergency Medicine, Taoyuan General Hospital, Taoyuan, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Wei-Jie Wang
- Division of Nephrology, Department of Internal Medicine, Taoyuan General Hospital, Taoyuan, Ministry of Health and Welfare, Taoyuan, Taiwan
| | - Hsin-Jen Chen
- Institute of Public Health, National Yang Ming University, Taipei, Taiwan
| | - Lin-Chien Lee
- Department of Physical Medicine and Rehabilitation, Cheng Hsin General Hospital, Taipei, Taiwan
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Rebollo Rubio A, Morales Asencio JM, Pons Raventos ME. Biomarkers associated with mortality in patients undergoing dialysis. J Ren Care 2017; 43:163-174. [DOI: 10.1111/jorc.12205] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Affiliation(s)
- Ana Rebollo Rubio
- Nephrology Service; Carlos Haya Regional University Hospital; Malaga Spain
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Browne OT, Allgar V, Bhandari S. Analysis of factors predicting mortality of new patients commencing renal replacement therapy 10 years of follow-up. BMC Nephrol 2014; 15:20. [PMID: 24444187 PMCID: PMC3902419 DOI: 10.1186/1471-2369-15-20] [Citation(s) in RCA: 16] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/17/2013] [Accepted: 01/16/2014] [Indexed: 01/15/2023] Open
Abstract
BACKGROUND The natural history of patients commencing dialysis in East Yorkshire is not well characterised and there is little convincing evidence which has studied the impact of potential factors prior to commencement of renal replacement therapy (RRT) at predicting mortality during dialysis. The aim of this study was to examine the previously published 5-year data on end stage renal disease and co-morbid risk factors for mortality at 10 years. METHODS An observational cohort study of subjects commencing dialysis in 2001/02 in East Yorkshire with a mean follow up from dialysis initiation of 8.8 years. Predictors of mortality were determined by univariate, multivariate analysis and survival via Kaplan-Meier analysis. Assessment of the utility of the Tangri risk calculator was carried out in addition to slope change in eGFR prior to dialysis commencement. RESULTS Baseline characteristics and the preferred mode of dialysis remained concordant with the original trial. The mortality rate at the end of the study period was 60% (56/94) with 30% (29) of patients having been transplanted. Highlighted in the 5 year data a significant proportion of mortality was made up of vascular disease and sepsis (71%) but this proportion had decreased (57%) by 10 years. Cardiac disease was the commonest cause of death but notably in 18% of patients, death was related to dialysis or withdrawal of treatment. Vascular disease and diabetes remained independent risk factors and predicative of mortality. Calcium-phosphate product which was associated in the early years with mortality was not in later years. Use of the risk calculator was predictive of commencement of RRT but not mortality but slope change in eGFR was predictive of mortality. CONCLUSIONS Although diabetes and vascular disease remained predictive of mortality, interestingly calcium-phosphate levels are no longer significant and may be a more specific predictor of early cardiac mortality. Slope eGFR changes prior to RRT are a predictor of mortality. We speculate that aggressive management of cardiac risk factors in addition to early transplantation may be key to influencing the impact of survival in this cohort in addition to possible measures to delay renal progression.
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Affiliation(s)
| | - Victoria Allgar
- Department of Statistics, Hull York Medical School and University of Hull Hull, UK
| | - Sunil Bhandari
- Hull York Medical School, Hull, East Yorkshire, UK
- Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, Kingston upon Hull HU32JZ, UK
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Salpeter SR, Luo EJ, Malter DS, Stuart B. Systematic review of noncancer presentations with a median survival of 6 months or less. Am J Med 2012; 125:512.e1-6. [PMID: 22030293 DOI: 10.1016/j.amjmed.2011.07.028] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/20/2011] [Revised: 05/28/2011] [Accepted: 07/09/2011] [Indexed: 12/22/2022]
Abstract
PURPOSE We report on clinical indicators of 6-month mortality in advanced noncancer illnesses and the effect of treatment on survival. METHODS The MEDLINE database was searched comprehensively to find studies evaluating survival for common advanced noncancer illnesses. We retrieved and evaluated studies that reported a median survival of ≤1 year and evaluated prognostic factors or effect of treatment on survival. We extracted data on presentations with median survivals of ≤6 months for heart failure, chronic obstructive pulmonary disease, dementia, geriatric failure to thrive, cirrhosis, and end-stage renal failure. Independent risk factors for survival were combined and included if their combination was associated with a 6-month mortality of ≥50%. RESULTS The search identified 1000 potentially relevant studies, of which 475 were retrieved and evaluated, and 74 were included. We report the common clinical presentations that are consistently associated with a 6-month median survival. Even though advanced noncancer syndromes differ clinically, a universal set of prognostic factors signals progression to terminal disease, including poor performance status, advanced age, malnutrition, comorbid illness, organ dysfunction, and hospitalization for acute decompensation. Generally, a 6-month median survival is associated with the presence of 2-4 of these factors. With few exceptions, these terminal presentations are quite refractory to treatment. CONCLUSION This systematic review summarizes prognostic factors common to advanced noncancer illness. There is little evidence at present that treatment prolongs survival at these terminal stages.
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Bonnet F, Gauthier E, Gin H, Hadjadj S, Halimi JM, Hannedouche T, Rigalleau V, Romand D, Roussel R, Zaoui P. Expert consensus on management of diabetic patients with impairment of renal function. DIABETES & METABOLISM 2011; 37 Suppl 2:S1-25. [DOI: 10.1016/s1262-3636(11)70961-2] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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