Kidney Week

Abstract: FR-PO469

Can Early Referral to Nephrologists Reduce All-Cause and Cardiovascular Mortality and How Long Can the Effect of Pre-Dialysis Nephrology Care Last after Dialysis Initiation?

Session Information

• CKD: Risk Factors for Incidence and Progression - II
  November 03, 2017 | Location: Hall H, Morial Convention Center
  Abstract Time: 10:00 AM - 10:00 AM

Category: Chronic Kidney Disease (Non-Dialysis)

• 301 CKD: Risk Factors for Incidence and Progression

Authors

• Iwata, Yukimasa, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Yukimasa Iwata,

• Takatsuka, Taisuke, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Taisuke Takatsuka,

• Yoshimura, Daisuke, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Daisuke Yoshimura,

• Okushima, Hiroki, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Hiroki Okushima,

• Iio, Rei, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Rei Iio,

• Shoji, Tatsuya, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Tatsuya Shoji,

• Hayashi, Terumasa, Osaka General Medical Center, Osaka-Shi, osaka-fu, Japan

Terumasa Hayashi,

Background

Although early referral (ER) to nephrologists before dialysis initiation has been recognized to improve overall survival in patients on maintenance dialysis, we don’t have any available data about how long the favorable effect of ER can last. Furthermore, its effect on cardiovascular (CV) mortality remains unclear. Thus, we conducted single center retrospective cohort study of incident dialysis patients to investigate the effect of ER on all-cause and CV mortality and how long ER could sustain its favorable effect on mortality after dialysis initiation.

Methods

A total of 875 patients with accurate clinical data and outcomes were extracted from 1131 patients who started chronic dialysis treatment from 2006 to 2015. Clinical status at dialysis initiation, all-cause and CV mortality were compared by referral timing (ER, referred to nephrologists more than 6 months before dialysis initiation; LR, other than ER). Cox and interval Cox proportional hazard model was used to evaluate the predictive factors for outcomes and how long favorable effect of ER on mortality could last after dialysis initiation.

Results

Median age and eGFR at dialysis were 70 years and 5.4 ml/min/1.73m², respectively. 654 patients were referred early (ER). 275 patients died and 82 of those from CV disease during the follow-up period (median, 40 months). Although, ER group showed fewer all-cause and CV mortality (Log-rank test; P=0.007, 0.019 respectively) than LR group (Figure1), multivariate Cox proportional analysis failed to show significant impact on all-cause and CV mortality. However, on the basis of the Kaplan-Meier curves, the excess overall survival among ER versus LR patients appeared limited to the several years of maintenance dialysis (Figure 1A). Thus, we built several interval Cox models: from onset of dialysis to 6, 12, 18, 24, 30 and 36 months of maintenance dialysis. The favorable effect of ER on overall survival was limited to the first 30 months on dialysis (Figure2).

Conclusion

ER was not associated with CV death, whereas ER may improve overall survival during early phase after dialysis initiation.