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Abstract: FR-PO801

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

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Robinson, Bruce M., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Morgenstern, Hal, University of Michigan, Ann Arbor, Michigan, United States
  • Karaboyas, Angelo, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Li, Yun, University of Michigan, Ann Arbor, Michigan, United States
  • Bieber, Brian, Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Hakim, Raymond M., Vanderbilt University, Franklin, Tennessee, United States
  • Hasegawa, Takeshi, Showa University, Yokohama, KANAGAWA, Japan
  • Jadoul, Michel Y., Cliniques Saint-Luc, University of Louvain Medical School, Brussels, Belgium
  • Schaeffner, Elke, Charite , Berlin, Germany
  • Vanholder, Raymond C., University Hospital Gent, Gent, Belgium
  • Pisoni, Ronald L., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
  • Port, Friedrich K., Arbor Research Collaborative for Health, Ann Arbor, Michigan, United States
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