Kidney Week

Abstract: SA-PO375

Residual Kidney Function and Sudden Cardiac Death Among Incident Hemodialysis Patients

Session Information

• Hemodialysis and Frequent Dialysis: CV and Risk Prediction
  November 05, 2022 | Location: Exhibit Hall, Orange County Convention Center‚ West Building
  Abstract Time: 10:00 AM - 12:00 PM

Category: Dialysis

• 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

• Okazaki, Masaki, University of California Irvine, Irvine, United States

Masaki Okazaki,

• Obi, Yoshitsugu, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Yoshitsugu Obi,

• Shafi, Tariq, The University of Mississippi Medical Center, Jackson, Mississippi, United States

Tariq Shafi,

• Rhee, Connie, University of California Irvine, Irvine, California, United States

Connie Rhee,

• Kalantar-Zadeh, Kamyar, University of California Irvine, Irvine, California, United States

Kamyar Kalantar-Zadeh,

Background

The survival benefit of residual kidney function (RKF) in hemodialysis patients is likely tied to advantages in fluid and electrolyte management. However, data have been lacking on the relationship between the RKF and sudden cardiac death (SCD). We therefore conducted a nationally representative cohort study to examine the association of RKF with SCD in patients initiating thrice-weekly in-center hemodialysis.

Methods

We analyzed a longitudinal data from a retrospective cohort study examining incident dialysis patients at a facility operated by a large dialysis organization in the U.S. from 2007 to 2011.
The predictor was RKF measured by renal urea clearance (CL_urea) at baseline and 6 months after initiating hemodialysis. Multivariable cause-specific proportional hazards models were fitted for primary analysis, and restricted cubic splines were fitted for secondary analysis for change in RKF to estimate SCD mortality.

Results

Baseline cohort of 39,749 patients were categorized into five groups according to baseline renal CL_urea (<1.5, 1.5 to <3.0, 3.0 to <4.5, 4.5 to <6.0, and ≥6.0 mL/min/1.73 m²). The mean age was 61.6 years, and the median baseline renal CL_urea was 3.1 mL/min/1.73 m². Among a total of 7,737 all-cause deaths, 1,909 SCDs (24.7%) with the incidence rate of 34.0 per 1,000 person-years were observed. Compared with patients who had baseline renal CL_urea of >6.0, those of <1.5 was associated with higher risk of SCD: case-mix adjusted hazard ratio was 1.47 (95% CI, 1.27–1.73). Of 12,169 patients with available data on change in renal CL_urea, a decline in renal CL_urea during the first 6 months of hemodialysis also showed a gradient association with increased SCD mortality.

Conclusion

Lower RKF and loss of RKF were associated with higher SCD mortality in patients starting thrice-weekly in-center hemodialysis.