Residual kidney function decline and mortality in incident hemodialysis patients

Yoshitsugu Obi, Connie M. Rhee, Anna T. Mathew, Gaurang Shah, Elani Streja, Steven M. Brunelli, Csaba Kovesdy, Rajnish Mehrotra, Kamyar Kalantar-Zadeh

Research output: Contribution to journalArticle

54 Citations (Scopus)

Abstract

In patients with ESRD, residual kidney function (RKF) contributes to achievement of adequate solute clearance. However, few studies have examined RKF in patients on hemodialysis. In a longitudinal cohort of 6538 patients who startedmaintenance hemodialysis over a 4-year period (January 2007 through December 2010) and had available renal urea clearance (CLurea) data at baseline and 1 year after hemodialysis initiation, we examined the association of annual change in renal CLurea rate with subsequent survival. The median (interquartile range) baseline value and mean6SD annual change of CLurea were 3.3 (1.9-5.0) and 21.162.8 ml/min per 1.73m2, respectively. GreaterCLurea rate 1 year after hemodialysis initiation associated with better survival. Furthermore,we found a gradient association between loss ofRKF and all-causemortality: changes in CLurea rate of26.0 and +3.0 ml/min per 1.73m2per year associatedwithcasemix-adjusted hazard ratios (95% confidence intervals) of 2.00 (1.55 to 2.59) and 0. 61 (0.50 to 0.74), respectively (reference: 21.5 ml/min per 1.73 m2 per year). These associations remained robust against adjustment for laboratory variables and ultrafiltration rate and were consistent across strata of baseline CLurea, age, sex, race, diabetes status, presence of congestive heart failure, and hemoglobin, serum albumin, and serum phosphorus levels. Sensitivity analyses using urine volume as another index of RKF yielded consistent associations. In conclusion, RKF decline during the first year of dialysis has a graded association with all-cause mortality among incident hemodialysis patients. The clinical benefits of RKF preservation strategies on mortality should be determined.

Original languageEnglish (US)
Pages (from-to)3758-3768
Number of pages11
JournalJournal of the American Society of Nephrology
Volume27
Issue number12
DOIs
StatePublished - Dec 1 2016

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Renal Dialysis
Kidney
Mortality
Survival
Ultrafiltration
Serum Albumin
Phosphorus
Chronic Kidney Failure
Urea
Dialysis
Hemoglobins
Heart Failure
Urine
Confidence Intervals
Serum

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Obi, Y., Rhee, C. M., Mathew, A. T., Shah, G., Streja, E., Brunelli, S. M., ... Kalantar-Zadeh, K. (2016). Residual kidney function decline and mortality in incident hemodialysis patients. Journal of the American Society of Nephrology, 27(12), 3758-3768. https://doi.org/10.1681/ASN.2015101142

Residual kidney function decline and mortality in incident hemodialysis patients. / Obi, Yoshitsugu; Rhee, Connie M.; Mathew, Anna T.; Shah, Gaurang; Streja, Elani; Brunelli, Steven M.; Kovesdy, Csaba; Mehrotra, Rajnish; Kalantar-Zadeh, Kamyar.

In: Journal of the American Society of Nephrology, Vol. 27, No. 12, 01.12.2016, p. 3758-3768.

Research output: Contribution to journalArticle

Obi, Y, Rhee, CM, Mathew, AT, Shah, G, Streja, E, Brunelli, SM, Kovesdy, C, Mehrotra, R & Kalantar-Zadeh, K 2016, 'Residual kidney function decline and mortality in incident hemodialysis patients', Journal of the American Society of Nephrology, vol. 27, no. 12, pp. 3758-3768. https://doi.org/10.1681/ASN.2015101142
Obi, Yoshitsugu ; Rhee, Connie M. ; Mathew, Anna T. ; Shah, Gaurang ; Streja, Elani ; Brunelli, Steven M. ; Kovesdy, Csaba ; Mehrotra, Rajnish ; Kalantar-Zadeh, Kamyar. / Residual kidney function decline and mortality in incident hemodialysis patients. In: Journal of the American Society of Nephrology. 2016 ; Vol. 27, No. 12. pp. 3758-3768.
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