Kidney Week

Abstract: FR-PO801

Estimating the Fraction of First-Year Hemodialysis Deaths Attributable to Potentially Modifiable Risk Factors: Results from the DOPPS

Session Information

• Dialysis: Hospitalization and Mortality
  October 26, 2018 | Location: Exhibit Hall, San Diego Convention Center
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Bruce M. Robinson,

• Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States

Hal Morgenstern,

• Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Angelo Karaboyas,

• Li, Yun, University of Michigan, Ann Arbor, Michigan, United States

Yun Li,

• Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Brian Bieber,

• Hakim, Raymond M., Vanderbilt University, Franklin, Tennessee, United States

Raymond M. Hakim,

• Hasegawa, Takeshi, Showa University, Yokohama, KANAGAWA, Japan

Takeshi Hasegawa,

• Jadoul, Michel Y., Cliniques Saint-Luc, University of Louvain Medical School, Brussels, Belgium

Michel Y. Jadoul,

• Schaeffner, Elke, Charite , Berlin, Germany

Elke Schaeffner,

• Vanholder, Raymond C., University Hospital Gent, Gent, Belgium

Raymond C. Vanholder,

• Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Ronald L. Pisoni,

• Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States

Friedrich K. Port,

Background

Despite recent improvements in survival on chronic hemodialysis (HD), mortality soon after HD start remains high. We aimed to identify potentially modifiable risk factors with the greatest impact on early HD mortality.

Methods

The analysis included 15,891 incident HD patients (<60 days on HD) from 21 countries in phases 1-5 (1996-2015) of the Dialysis Outcomes and Practice Patterns Study (DOPPS). Using adjusted Cox regression, we estimated the fraction of deaths in the first year of HD attributable to potentially modifiable risk factors at study entry (the attributable fraction, AF) by comparing predicted survival based on risk factors observed vs. counterfactually set to reference levels.

Results

Of 12 risk factor chosen based on known mortality associations, the highest AFs were observed for catheter use (22%), serum albumin <3.5 g/dL (19%), and serum creatinine <6 mg/dL (12%). Risk factors with an AF of 5-9% were lack of pre-HD nephrology care, lack of residual urine volume, SBP out of range 130-160 mm Hg, phosphorus out of range 3.5-5.5 mg/dL, hemoglobin out of range 10-12 g/dL, and WBC count >10,000/μL. The AFs for ferritin >800 ng/mL, serum calcium out of range 8.4-9.5 mg/dL and PTH out of range 150-300 pg/mL were <3%. Overall, 65% (95% CI 59-71%) of deaths were attributable to these 12 risk factors. The AF for CRP was 21% in facilities where it is routinely measured.

Conclusion

A substantial proportion of first-year HD deaths could potentially be reduced by successfully modifying a few risk factors. Highest priority targets should include decreasing catheter use and avoiding or treating malnutrition/inflammation whenever possible.

Funding

• NIDDK Support – The DOPPS Program is supported by Amgen, Kyowa Hakko Kirin, Baxter Healthcare. Additional support for specific projects and countries is provided by AstraZeneca, European Renal Association-European Dialysis & Transplant Association (ERA-EDTA), Fresenius Medical Care Asia-Pacific Ltd, Fresenius Medical Care Canada Ltd, German Society of Nephrology (DGfN), Janssen, Japanese Society for Peritoneal Dialysis (JSPD), Keryx, Kidney Care UK, MEDICE Arzneimittel Pütter GmbH & Co KG, Proteon, and Vifor Fresenius Medical Care Renal Pharma. Public funding and support is provided for specific DOPPS projects, ancillary studies, or affiliated research projects by National Health & Medical Research Council (NHMRC) in Australia, Cancer Care Ontario (CCO) through the Ontario Renal Network (ORN) in Canada, French National Institute of Health and Medical Research (INSERM) in France, Thailand Research Foundation (TRF), Chulalongkorn University Matching Fund, King Chulalongkorn Memorial Hospital Matching Fund, and the National Research Council of Thailand (NRCT) in Thailand, National Institute for Health Research (NIHR) via the Comprehensive Clinical Research Network (CCRN) in the United Kingdom, and National Institutes of Health (NIH) in the US. All support is provided without restrictions on publications. All grants are made to Arbor Research Collaborative for Health and not to Dr. Robinson directly.