Kidney Week

Abstract: FR-PO807

Estimated Glomerular Filtration Rate (eGFR) at Initiation of Hemodialysis and Long Term Mortality

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

• Aboud, Hussain, University of Florida, Gainesville, Florida, United States

Hussain Aboud,

• Bozorgmehri, Shahab, University of Florida, Gainesville, Florida, United States

Shahab Bozorgmehri,

• Ozrazgat-baslanti, Tezcan, University of Florida, Gainesville, Florida, United States

Tezcan Ozrazgat-baslanti,

• Liu, I-Chia, University of Florida, Gainesville, Florida, United States

I-Chia Liu,

• Kazory, Amir, University of Florida, Gainesville, Florida, United States

Amir Kazory,

• Shukla, Ashutosh M., University of Florida, Gainesville, Florida, United States

Ashutosh M. Shukla,

• Bihorac, Azra, University of Florida, Gainesville, Florida, United States

Azra Bihorac,

• Segal, Mark S., University of Florida, Gainesville, Florida, United States

Mark S. Segal,

• Mohandas, Rajesh, University of Florida, Gainesville, Florida, United States

Rajesh Mohandas,

Background

The results of the Initiating Dialysis Early and Late (IDEAL) study suggested that patients with stage V CKD, randomized to late initiation of Hemodialysis (HD) had similar mortality to those who started early. However, more than 3/4th of patients assigned to the late arm received dialysis earlier than planned. Moreover, IDEAL study population was very different from that of the United States and had close nephrology followup. We used a propensity score based analysis of the USRDS database to examine how the eGFR at the time of initiation of dialysis affects total and cardiovascular (CV) mortality in the US population in a real word setting.

Methods

Patients ≥18 years old who initiated in-center HD between 2006 and 2014 were included. 676,196 patients were categorized based on the tertiles of MDRD eGFR levels prior to initiation of HD, into late (eGFR <8.7), intermediate (eGFR 8.7 to <13.0) and ≥ and early start (eGFR >13.0 ml/min) groups. Associations between eGFR groups and 10-year all-cause and CV mortality were assessed using KM curves and multivariable Cox proportional hazards models with propensity-score weighted regression.

Results

Mean age was 64±15 years. Elderly, Caucasians, males and those with diabetes or heart failure were more likely to be initiated on HD early. Compared to the late start group, the intermediate and early start had a 42% and 93% increased risk of 10-year all-cause mortality, respectively (HR=1.42; 95%CI: 1.41-1.43 and HR=1.93; 95%CI: 1.91-1.94 respectively). This association was attenuated, but remained significant when adjusted for multiple covariates (adjusted HR=1.13; 95%CI:1.12-1.14 for intermediate and HR=1.37; 95%CI: 1.36-1.39, for early start respectively).The 10-year CV mortality was similarly increased with early dialysis (adjusted HR=1.13; 95%CI: 1.12-1.15 and HR=1.40; 95%CI: 1.38-1.42, for late and early start respectively). This association was robust and consistent across multiple sub-groups and sensitivity analyses.

Conclusion

Our results demonstrate that early initiation of dialysis is associated with increased toal and cardiovascular mortality. This increased mortality is not completely accounted for by co-morbidities in the early initiation group. The mechanistic basis of these observation requires further study.

Funding

• Other NIH Support