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Malek R, Baghestani A, Rashid-Farokhi F, Shafaghi S, Minoo F, Eghbali F, Chandra N, Shafaghi M, Bonyadi K, Hosseini-Baharanchi FS. Evaluation of laboratory values affecting mortality of end-stage renal disease patients: a competing risks approach. BMC Nephrol 2023; 24:213. [PMID: 37464291 DOI: 10.1186/s12882-023-03234-x] [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: 09/04/2022] [Accepted: 06/06/2023] [Indexed: 07/20/2023] Open
Abstract
BACKGROUND Chronic Kidney Disease (CKD) is a prevalent and life-threatening situation recognized as an emerging health issue. The present study aimed to evaluate the effect of demographic and laboratory parameters on the survival of patients with End-Stage Renal Disease (ESRD) in a hemodialysis (HD) center in Iran. MATERIALS AND METHODS This study was conducted on patients receiving chronic HD in Iran Helal Pharmaceutical and Clinical Complex between 2014 and 2018. The survival time was considered as the time interval between HD initiation and death. Receiving kidney transplantation was regarded as a competing risk, and an improper form of two-parameter Weibull distribution was utilized to simultaneously model the time to both death and renal transplantation. The Bayesian approach was conducted for parameters estimation. RESULTS Overall, 29 (26.6%) patients expired, and 19 (17.4%) received kidney transplants. The male gender was related to poor survival, having nearly 4.6 folds higher hazard of mortality (90% HPD region: 1.36-15.49). Moreover, Serum calcium levels [Formula: see text]9.5 mg/dL (adjusted Sub-hazard ratio (S-HR)=2.33, 90% HPD region: 1.05-5.32) and intact parathyroid hormone (iPTH) [Formula: see text]150 pg/mL (adjusted S-HR = 2.56, 90% HPD region: 1.09-6.15) were associated with an elevated hazard of mortality. The cumulative incidence function (CIF) for transplantation was greater than death in the first two years of the study. Subsequently, the CIF for death exceeded transplantation in the following two years. The 4-year cumulative incidence of death and kidney transplantation was 63.7% and 36.3%, respectively. CONCLUSION Male gender, hypercalcemia, and hypoparathyroidism were associated with worse outcomes. Correcting mentioned laboratory parameters may improve patients' survival in the HD population.
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Affiliation(s)
- Rayka Malek
- School of Population Health sciences, King's College London, London, UK
| | - Ahmadreza Baghestani
- Department of Biostatistics, Faculty of Paramedical Sciences, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farin Rashid-Farokhi
- Telemedicine Research Center, & Chronic Kidney Disease Research Center, Masih Daneshvari Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Shadi Shafaghi
- Lung Transplantation Research Center, National Research Institute of Tuberculosis and Lung Diseases, Shahid Beheshti University of Medical Sciences, Tehran, Iran
| | - Farzanehsadat Minoo
- Center of Excellence in Nephrology, Nephrology Research Center, Tehran University of Medical Sciences, Tehran, Iran
| | - Foolad Eghbali
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran
| | - Navin Chandra
- Department of Statistics, Ramanujan School of Mathematical Sciences, Pondicherry University, Puducherry, India
| | - Masoud Shafaghi
- Strategic Planning and Executive Office Manager, International Federation of Inventors' Associations, Geneva, Switzerland
| | - Kaveh Bonyadi
- Department of Biomedical (Biomechanics), Science and Research Branch, Islamic Azad University, Tehran, Iran
| | - Fatemeh Sadat Hosseini-Baharanchi
- Minimally Invasive Surgery Research Center, Iran University of Medical Sciences, Tehran, Iran.
- Department of Biostatistics, School of Public Health, Iran University of Medical Sciences, Tehran, Iran.
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Jiang C, Zheng Q. Outcomes of peritoneal dialysis in elderly vs non-elderly patients: A systemic review and meta-analysis. PLoS One 2022; 17:e0263534. [PMID: 35134073 PMCID: PMC8824377 DOI: 10.1371/journal.pone.0263534] [Citation(s) in RCA: 8] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2021] [Accepted: 01/21/2022] [Indexed: 11/18/2022] Open
Abstract
OBJECTIVES Several studies have compared outcomes of peritoneal dialysis (PD) between elderly and non-elderly patients but with variable results. We hereby designed this review to compare mortality, peritonitis, and technique survival between elderly and non-elderly patients on PD. METHODS PubMed, Embase, and Google Scholar were searched for studies comparing outcomes of PD between elderly and non-elderly patients. The last search date was 14th July 2021. RESULTS Fourteen studies were included. 12 studies defined the elderly as ≥65 years of age and these were included in the meta-analysis. Pooled analysis of crude (RR: 2.45 95% CI: 1.36, 4.40 I2 = 97% p = 0.003) and adjusted data (HR: 2.80 95% CI: 2.45, 3.09 I2 = 0% p<0.00001) indicated a statistically significant increased risk of mortality amongst elderly patients as compared to non-elderly patients. Meta-analysis of four studies demonstrated a statistically significant increased risk of peritonitis in the elderly (RR: 1.56 95% CI: 1.18, 2.07 I2 = 76% p = 0.002). Pooled analysis demonstrated no statistically significant difference in technique survival between the two groups (RR: 0.95 95% CI: 0.86, 1.05 I2 = 86% p = 0.32). CONCLUSION Elderly patients on PD have a significantly increased risk of mortality as compared to non-elderly patients. The risk of peritonitis is also significantly increased in older adults but the increased age has no impact on technique survival. Further studies are needed to strengthen our conclusions.
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Affiliation(s)
- Chunling Jiang
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
| | - Qiang Zheng
- Department of nephrology, The affiliated People’s Hospital with Jiangsu University, Zhenjiang, Jiangsu, P.R.China
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Nierenersatzverfahren bei Hochbetagten. DER NEPHROLOGE 2021; 16:261-268. [PMID: 34405030 PMCID: PMC8361401 DOI: 10.1007/s11560-021-00518-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Accepted: 07/12/2021] [Indexed: 11/03/2022]
Abstract
Hochbetagte haben an der Hämodialyse eine 1‑Jahres-Mortalität, die im Zusammenhang mit Komorbiditäten und einem Katheter als Dialysezugang 30 % übersteigt. Metaanalysen zeigen aber, dass frühzeitige Vorbereitung und individuelle Verfahrensauswahl die Morbidität und Mortalität auch im hohen Lebensalter entscheidend bessern. Mit zunehmendem Alter und Gebrechlichkeit verschieben sich dabei die Behandlungsziele weg von der Verlängerung der Lebensdauer auf die Verbesserung der Lebensqualität. Damit kann die Präferenz von Heimdialyseverfahren, auch als assistierte Peritonealdialyse, ebenso Bedeutung erringen wie die fachnephrologische Behandlung ohne Nierenersatzverfahren mit palliativem Therapieziel. Im höheren Lebensalter bestimmen zunehmend Komorbiditäten, kognitive Einschränkungen, Gebrechlichkeit und die Gesamtprognose das sinnvolle Vorgehen. Bereits bei der Anlage von Gefäßzugängen ergeben sich hinsichtlich Anastomosenort und Anlagezeitpunkt bei Hochbetagten andere Entscheidungskriterien. Empfehlungen zu Dialysedauer und -frequenz folgen der Lebensqualität mit inkrementellen und am Ende des Lebens auch dekrementellen Therapieregimen. Die demographische Entwicklung stellt die Nephrologie mit einer Zunahme älterer Patienten vor besondere Herausforderungen. Frühzeitige Aufklärung über alle Nierenersatzverfahren und die Festlegung individueller Therapieziele können bei sorgfältiger Auswahl von Dialysemodalität und -intensität auch bei Hochbetagten entscheidend zur Verbesserung der Prognose und insbesondere der Lebensqualität beitragen.
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Sousa H, Ribeiro O, Costa E, Frontini R, Paúl C, Amado L, Miranda V, Ribeiro F, Figueiredo D. Being on hemodialysis during the COVID-19 outbreak: A mixed-methods' study exploring the impacts on dialysis adequacy, analytical data, and patients' experiences. Semin Dial 2020; 34:66-76. [PMID: 32939844 DOI: 10.1111/sdi.12914] [Citation(s) in RCA: 25] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/29/2020] [Revised: 07/28/2020] [Accepted: 08/16/2020] [Indexed: 12/17/2022]
Abstract
For individuals with end-stage renal disease (ESRD), the novel coronavirus can present several additional challenges in disease self-management. This study aimed to explore the impacts of the COVID-19 pandemic in non-COVID-19 patients with ESRD undergoing in-center hemodialysis (HD). A mixed-methods study was conducted with a purposive sample recruited from one dialysis unit in Portugal. Quantitative data were collected retrospectively from patients' medical records from February 2020 (T1-before the outbreak) and from April 2020 (T2-during lockdown). Semi-structured interviews were conducted with 20 patients (66.9 ± 11.9 years old) undergoing HD for an average of 46.1 months (±39.5) in April 2020. Overall results suggested that dialysis adequacy and serum albumin levels decreased significantly at T2, while phosphorus levels increased. The findings from thematic analysis suggested several psychosocial negative impacts and impacts on disease and treatment-related health behaviors (eg, difficulties managing dietary restrictions during the lockdown and diminished physical activity), which can partially explain these quantitative results. However, some patients were also able to find positive impacts in this experience and problem-focused and emotional strategies were identified to cope with the demands of COVID-19. Several recommendations have been made to mitigate patients' emotional, relational, and educational unmet needs during the current pandemic and in the event of new outbreaks.
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Affiliation(s)
- Helena Sousa
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Oscar Ribeiro
- Center for Health Technology and Services Research (CINTESIS.UA), Department of Education and Psychology, University of Aveiro, Aveiro, Portugal
| | - Elísio Costa
- Research Unit on Applied Molecular Biosciences (UCIBIO - REQUIMTE), Faculty of Pharmacy, University of Porto, Porto, Portugal
| | - Roberta Frontini
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Constança Paúl
- Center for Health Technology and Services Research (CINTESIS), Institute of Biomedical Sciences Abel Salazar, University of Porto, Porto, Portugal
| | | | | | - Fernando Ribeiro
- Institute for Biomedicine (iBiMED), School of Health Sciences, University of Aveiro, Aveiro, Portugal
| | - Daniela Figueiredo
- Center for Health Technology and Services Research (CINTESIS.UA), School of Health Sciences, University of Aveiro, Aveiro, Portugal
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Karthikeyan B, Sharma RK, Kaul A, Gupta A, Prasad N, Bhadauria DS. Clinical Characteristics, Patient and Technique Survival in Elderly Patients on Peritoneal Dialysis. Indian J Nephrol 2019; 29:334-339. [PMID: 31571740 PMCID: PMC6755933 DOI: 10.4103/ijn.ijn_377_18] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/23/2022] Open
Abstract
The outcomes of the elderly population on peritoneal dialysis (PD) in developing countries are less known. In this study, we intended to study the clinical characteristics and patient and technique survival of elderly patients on PD. In this study, data of 148 elderly patients with end-stage renal disease who initiated PD between January 2001 and December 2015 were collected. Baseline clinical characteristics and events during the study period were recorded. Overall patient and technique survival rates of diabetic and non-diabetic elderly patients on PD were analyzed. Around 128 patients who were initiated PD during the study period were included for final analysis. The mean age of the study group was 70.3 ± 5.1 years, and 94 (80%) were males. Among these, 79 (65.8%) had diabetes. At the end of the study period, only 20 (16.6%) patients were remained on PD. Eighty-four (70%) patients died during PD and 15 (12.5%) patients were transferred to hemodialysis during the study period. The main reasons for death were cardiovascular (56.6%) and sepsis due to peritonitis (18.8%). The mean patient survival time was 38.2 ± 2.6 months. The patient survival rates were 91.2%, 45.3%, and 22.8% at 1, 3, and 5 years, respectively. Predictors of mortality were increased serum phosphorus, peritonitis episodes, urine output <400 mL, and ultrafiltration <1000 mL/day at beginning of PD. The mean technique survival time was 92.0 ± 5.1 months. Technique survival rates at 1, 3, and 5 years were 94.8%, 85.3%, and 71.7%, respectively. None of the factors was found to be predictive of technique survival. We found no significant difference between diabetic and non-diabetic patients in terms of technique and patient survival. Mortality was higher in elderly patients on PD. Factors affecting mortality in elderly patients on PD are low urine output, low ultrafiltration at beginning of PD, high serum phosphorus, and presence of peritonitis episodes. Patient and technique survival rates were comparable between diabetic and non-diabetic elderly patients on PD.
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Affiliation(s)
| | - Raj K Sharma
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Anupama Kaul
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Amit Gupta
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Narayan Prasad
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
| | - Dharmendra S Bhadauria
- Department of Nephrology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, Uttar Pradesh, India
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Artificial Intelligence Prediction Model for the Cost and Mortality of Renal Replacement Therapy in Aged and Super-Aged Populations in Taiwan. J Clin Med 2019; 8:jcm8070995. [PMID: 31323939 PMCID: PMC6678226 DOI: 10.3390/jcm8070995] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/12/2019] [Revised: 07/08/2019] [Accepted: 07/08/2019] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Prognosis of the aged population requiring maintenance dialysis has been reportedly poor. We aimed to develop prediction models for one-year cost and one-year mortality in aged individuals requiring dialysis to assist decision-making for deciding whether aged people should receive dialysis or not. METHODS We used data from the National Health Insurance Research Database (NHIRD). We identified patients first enrolled in the NHIRD from 2000-2011 for end-stage renal disease (ESRD) who underwent regular dialysis. A total of 48,153 Patients with ESRD aged ≥65 years with complete age and sex information were included in the ESRD cohort. The total medical cost per patient (measured in US dollars) within one year after ESRD diagnosis was our study's main outcome variable. We were also concerned with mortality as another outcome. In this study, we compared the performance of the random forest prediction model and of the artificial neural network prediction model for predicting patient cost and mortality. RESULTS In the cost regression model, the random forest model outperforms the artificial neural network according to the mean squared error and mean absolute error. In the mortality classification model, the receiver operating characteristic (ROC) curves of both models were significantly better than the null hypothesis area of 0.5, and random forest model outperformed the artificial neural network. Random forest model outperforms the artificial neural network models achieved similar performance in the test set across all data. CONCLUSIONS Applying artificial intelligence modeling could help to provide reliable information about one-year outcomes following dialysis in the aged and super-aged populations; those with cancer, alcohol-related disease, stroke, chronic obstructive pulmonary disease (COPD), previous hip fracture, osteoporosis, dementia, and previous respiratory failure had higher medical costs and a high mortality rate.
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