Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters

John J. Sim, Hui Zhou, Jiaxiao Shi, Sally F. Shaw, Shayna L. Henry, Csaba Kovesdy, Kamyar Kalantar-Zadeh, Steven J. Jacobsen

Research output: Contribution to journalArticle

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Abstract

Purpose: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD. Methods: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed. Multivariable Cox regression modeling was used to estimate 6-month all-cause mortality hazard ratios (HR) among the three treatment groups after adjustment for patient and clinical characteristics. Results: Among 5373 ESRD patients (62.7 years, 41.3% females, 37.5% Hispanics, 13.3% PD, 34.9% HD with fistula/graft, 51.8% HD with catheter), 551 (10.3%) died at 6 months. Mortality rates were highest immediately after transition (299 deaths per 1000 person-years in first month). Compared to PD patients, the 6-month mortality HR (95% CI) was 1.87 (1.06–3.30) in HD with fistula/graft patients and 3.77 (2.17–6.57) in HD with catheter patients. Inpatient transition (HR 1.32), acute kidney injury (HR 2.06), and an eGFR ≥ 15 vs 5–9 (HR 1.68) at transition were also associated with higher early mortality risk. Conclusion: Among a diverse CKD population who transitioned to ESRD, we observed considerable differences in early mortality risk among PD, HD with fistula/graft, and HD with catheter patients. The identification of patient-specific and clinical environmental factors related to high early mortality may provide insights for managing advanced stages of CKD and shared decision making.

Original languageEnglish (US)
Pages (from-to)963-971
Number of pages9
JournalInternational Urology and Nephrology
Volume50
Issue number5
DOIs
StatePublished - May 1 2018

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Patient Transfer
Peritoneal Dialysis
Chronic Renal Insufficiency
Renal Dialysis
Catheters
Mortality
Chronic Kidney Failure
Fistula
Transplants
Population
Arteriovenous Fistula
Hispanic Americans
Acute Kidney Injury
Inpatients
Decision Making
Cohort Studies
Retrospective Studies

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Urology

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Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters. / Sim, John J.; Zhou, Hui; Shi, Jiaxiao; Shaw, Sally F.; Henry, Shayna L.; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar; Jacobsen, Steven J.

In: International Urology and Nephrology, Vol. 50, No. 5, 01.05.2018, p. 963-971.

Research output: Contribution to journalArticle

Sim, John J. ; Zhou, Hui ; Shi, Jiaxiao ; Shaw, Sally F. ; Henry, Shayna L. ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar ; Jacobsen, Steven J. / Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters. In: International Urology and Nephrology. 2018 ; Vol. 50, No. 5. pp. 963-971.
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abstract = "Purpose: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD. Methods: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed. Multivariable Cox regression modeling was used to estimate 6-month all-cause mortality hazard ratios (HR) among the three treatment groups after adjustment for patient and clinical characteristics. Results: Among 5373 ESRD patients (62.7 years, 41.3{\%} females, 37.5{\%} Hispanics, 13.3{\%} PD, 34.9{\%} HD with fistula/graft, 51.8{\%} HD with catheter), 551 (10.3{\%}) died at 6 months. Mortality rates were highest immediately after transition (299 deaths per 1000 person-years in first month). Compared to PD patients, the 6-month mortality HR (95{\%} CI) was 1.87 (1.06–3.30) in HD with fistula/graft patients and 3.77 (2.17–6.57) in HD with catheter patients. Inpatient transition (HR 1.32), acute kidney injury (HR 2.06), and an eGFR ≥ 15 vs 5–9 (HR 1.68) at transition were also associated with higher early mortality risk. Conclusion: Among a diverse CKD population who transitioned to ESRD, we observed considerable differences in early mortality risk among PD, HD with fistula/graft, and HD with catheter patients. The identification of patient-specific and clinical environmental factors related to high early mortality may provide insights for managing advanced stages of CKD and shared decision making.",
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T1 - Disparities in early mortality among chronic kidney disease patients who transition to peritoneal dialysis and hemodialysis with and without catheters

AU - Sim, John J.

AU - Zhou, Hui

AU - Shi, Jiaxiao

AU - Shaw, Sally F.

AU - Henry, Shayna L.

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

AU - Jacobsen, Steven J.

PY - 2018/5/1

Y1 - 2018/5/1

N2 - Purpose: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD. Methods: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed. Multivariable Cox regression modeling was used to estimate 6-month all-cause mortality hazard ratios (HR) among the three treatment groups after adjustment for patient and clinical characteristics. Results: Among 5373 ESRD patients (62.7 years, 41.3% females, 37.5% Hispanics, 13.3% PD, 34.9% HD with fistula/graft, 51.8% HD with catheter), 551 (10.3%) died at 6 months. Mortality rates were highest immediately after transition (299 deaths per 1000 person-years in first month). Compared to PD patients, the 6-month mortality HR (95% CI) was 1.87 (1.06–3.30) in HD with fistula/graft patients and 3.77 (2.17–6.57) in HD with catheter patients. Inpatient transition (HR 1.32), acute kidney injury (HR 2.06), and an eGFR ≥ 15 vs 5–9 (HR 1.68) at transition were also associated with higher early mortality risk. Conclusion: Among a diverse CKD population who transitioned to ESRD, we observed considerable differences in early mortality risk among PD, HD with fistula/graft, and HD with catheter patients. The identification of patient-specific and clinical environmental factors related to high early mortality may provide insights for managing advanced stages of CKD and shared decision making.

AB - Purpose: The early period after chronic kidney disease (CKD) patients transition to end-stage renal disease (ESRD) represents the highest mortality risk but is variable among different patient populations and clinical circumstances. We compared early mortality outcomes among a diverse CKD population that transitioned to ESRD. Methods: A retrospective cohort study (1/1/2002 through 12/31/2013) of CKD patients (age ≥ 18 years) who transitioned to peritoneal dialysis (PD), hemodialysis (HD) with arteriovenous fistula/grafts, and HD with catheters was performed. Multivariable Cox regression modeling was used to estimate 6-month all-cause mortality hazard ratios (HR) among the three treatment groups after adjustment for patient and clinical characteristics. Results: Among 5373 ESRD patients (62.7 years, 41.3% females, 37.5% Hispanics, 13.3% PD, 34.9% HD with fistula/graft, 51.8% HD with catheter), 551 (10.3%) died at 6 months. Mortality rates were highest immediately after transition (299 deaths per 1000 person-years in first month). Compared to PD patients, the 6-month mortality HR (95% CI) was 1.87 (1.06–3.30) in HD with fistula/graft patients and 3.77 (2.17–6.57) in HD with catheter patients. Inpatient transition (HR 1.32), acute kidney injury (HR 2.06), and an eGFR ≥ 15 vs 5–9 (HR 1.68) at transition were also associated with higher early mortality risk. Conclusion: Among a diverse CKD population who transitioned to ESRD, we observed considerable differences in early mortality risk among PD, HD with fistula/graft, and HD with catheter patients. The identification of patient-specific and clinical environmental factors related to high early mortality may provide insights for managing advanced stages of CKD and shared decision making.

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