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Int Urol Nephrol. 2018 May;50(5):963-971. doi: 10.1007/s11255-018-1837-6. Epub 2018 Mar 12.

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

Author information

1
Division of Nephrology and Hypertension, Kaiser Permanente Los Angeles Medical Center, 4700 Sunset Bl, Los Angeles, CA, USA. John.j.sim@kp.org.
2
Department of Research and Evaluation, Kaiser Permanente Southern California, Pasadena, CA, USA.
3
Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
4
Division of Nephrology and Hypertension, University of California Irvine Medical Center, Irvine, CA, USA.

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.

KEYWORDS:

Chronic kidney disease; Comparative outcomes; End-stage renal disease transition; Epidemiology; Mortality

PMID:
29532308
PMCID:
PMC5936478
[Available on 2019-05-01]
DOI:
10.1007/s11255-018-1837-6
[Indexed for MEDLINE]

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