Impact of residual kidney function on hemodialysis adequacy and patient survival

Mengjing Wang, Yoshitsugu Obi, Elani Streja, Connie M. Rhee, Jing Chen, Chuanming Hao, Csaba Kovesdy, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

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Abstract

Background. Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods. Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007 11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results. The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74 4.85] mL/min/1.73 m2 and 1.3260.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5 2.2 years) with an incidence of 15.4 deaths per 100 patientyears. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e.<3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (1.2) spKt/V were 1.40 (1.12 1.74), 1.21 (1.10 1.33), 1.06 (0.98 1.14), and 1.00 (0.93 1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions. Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.

Original languageEnglish (US)
Pages (from-to)1823-1831
Number of pages9
JournalNephrology Dialysis Transplantation
Volume33
Issue number10
DOIs
StatePublished - Oct 1 2018

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Renal Dialysis
Kidney
Survival
Dialysis
Mortality
Proportional Hazards Models
Risk Adjustment
Survival Analysis
Urea
Organizations
Confidence Intervals
Incidence

All Science Journal Classification (ASJC) codes

  • Nephrology
  • Transplantation

Cite this

Wang, M., Obi, Y., Streja, E., Rhee, C. M., Chen, J., Hao, C., ... Kalantar-Zadeh, K. (2018). Impact of residual kidney function on hemodialysis adequacy and patient survival. Nephrology Dialysis Transplantation, 33(10), 1823-1831. https://doi.org/10.1093/ndt/gfy060

Impact of residual kidney function on hemodialysis adequacy and patient survival. / Wang, Mengjing; Obi, Yoshitsugu; Streja, Elani; Rhee, Connie M.; Chen, Jing; Hao, Chuanming; Kovesdy, Csaba; Kalantar-Zadeh, Kamyar.

In: Nephrology Dialysis Transplantation, Vol. 33, No. 10, 01.10.2018, p. 1823-1831.

Research output: Contribution to journalArticle

Wang, M, Obi, Y, Streja, E, Rhee, CM, Chen, J, Hao, C, Kovesdy, C & Kalantar-Zadeh, K 2018, 'Impact of residual kidney function on hemodialysis adequacy and patient survival', Nephrology Dialysis Transplantation, vol. 33, no. 10, pp. 1823-1831. https://doi.org/10.1093/ndt/gfy060
Wang, Mengjing ; Obi, Yoshitsugu ; Streja, Elani ; Rhee, Connie M. ; Chen, Jing ; Hao, Chuanming ; Kovesdy, Csaba ; Kalantar-Zadeh, Kamyar. / Impact of residual kidney function on hemodialysis adequacy and patient survival. In: Nephrology Dialysis Transplantation. 2018 ; Vol. 33, No. 10. pp. 1823-1831.
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abstract = "Background. Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods. Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007 11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results. The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74 4.85] mL/min/1.73 m2 and 1.3260.28, respectively. A total of 7444 (23{\%}) patients died during the median follow-up of 1.2 years (IQR 0.5 2.2 years) with an incidence of 15.4 deaths per 100 patientyears. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e.<3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95{\%} confidence intervals of the low (<1.2) versus high (1.2) spKt/V were 1.40 (1.12 1.74), 1.21 (1.10 1.33), 1.06 (0.98 1.14), and 1.00 (0.93 1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions. Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.",
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T1 - Impact of residual kidney function on hemodialysis adequacy and patient survival

AU - Wang, Mengjing

AU - Obi, Yoshitsugu

AU - Streja, Elani

AU - Rhee, Connie M.

AU - Chen, Jing

AU - Hao, Chuanming

AU - Kovesdy, Csaba

AU - Kalantar-Zadeh, Kamyar

PY - 2018/10/1

Y1 - 2018/10/1

N2 - Background. Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods. Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007 11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results. The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74 4.85] mL/min/1.73 m2 and 1.3260.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5 2.2 years) with an incidence of 15.4 deaths per 100 patientyears. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e.<3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (1.2) spKt/V were 1.40 (1.12 1.74), 1.21 (1.10 1.33), 1.06 (0.98 1.14), and 1.00 (0.93 1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions. Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.

AB - Background. Both dialysis dose and residual kidney function (RKF) contribute to solute clearance and are associated with outcomes in hemodialysis patients. We hypothesized that the association between dialysis dose and mortality is attenuated with greater RKF. Methods. Among 32 251 incident hemodialysis patients in a large US dialysis organization (2007 11), we examined the interaction between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in survival analyses using multivariable Cox proportional hazards regression model. Results. The median rCLurea and mean baseline spKt/V were 3.06 [interquartile range (IQR) 1.74 4.85] mL/min/1.73 m2 and 1.3260.28, respectively. A total of 7444 (23%) patients died during the median follow-up of 1.2 years (IQR 0.5 2.2 years) with an incidence of 15.4 deaths per 100 patientyears. The Cox model with adjustment for case-mix and laboratory variables showed that rCLurea modified the association between spKt/V and mortality (Pinteraction 0.03); lower spKt/V was associated with higher mortality among patients with low rCLurea (i.e.<3 mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) versus high (1.2) spKt/V were 1.40 (1.12 1.74), 1.21 (1.10 1.33), 1.06 (0.98 1.14), and 1.00 (0.93 1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 6.0 mL/min/1.73 m2, respectively. Conclusions. Incident hemodialysis patients with substantial RKF do not exhibit the expected better survival at higher hemodialysis doses. RKF levels should be taken into account when deciding on the dose of dialysis treatment among incident hemodialysis patients.

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