Temporal changes and risk factors for death from early withdrawal within 12 months of dialysis initiation-a cohort study.

Adult Cohort Studies Female Humans Kidney Failure, Chronic / therapy Male Registries Renal Dialysis / adverse effects Renal Insufficiency Risk Factors
dialysis frailty kidney supportive care mortality treatment withdrawal

Journal

Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association
ISSN: 1460-2385
Titre abrégé: Nephrol Dial Transplant
Pays: England
ID NLM: 8706402

Informations de publication

Date de publication:
25 03 2022
Historique:
received: 11 04 2021
pubmed: 28 6 2021
medline: 27 4 2022
entrez: 27 6 2021
Statut: ppublish

Résumé

Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain. Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses. Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease; obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals. Death from dialysis withdrawal accounted for >30% of early deaths in kidney failure patients initiated on dialysis and remained unchanged over the past two decades. Several shared risk factors were observed between mortality attributed to early psychosocial and medical withdrawals.

Sections du résumé

BACKGROUND
Mortality risk is high soon after dialysis initiation in patients with kidney failure, and dialysis withdrawal is a major cause of early mortality, attributed to psychosocial or medical reasons. The temporal trends and risk factors associated with cause-specific early dialysis withdrawal within 12 months of dialysis initiation remain uncertain.
METHODS
Using data from the Australia and New Zealand Dialysis and Transplant Registry, we examined the temporal trends and risk factors associated with mortality attributed to early psychosocial and medical withdrawals in incident adult dialysis patients in Australia between 2005 and 2018 using adjusted competing risk analyses.
RESULTS
Of 32 274 incident dialysis patients, 3390 (11%) experienced death within 12 months post-dialysis initiation. Of these, 1225 (36%) were attributed to dialysis withdrawal, with 484 (14%) psychosocial withdrawals and 741 (22%) medical withdrawals. These patterns remained unchanged over the past two decades. Factors associated with increased risk of death from early psychosocial and medical withdrawals were older age, dialysis via central venous catheter, late referral and the presence of cerebrovascular disease; obesity and Asian ethnicity were associated with decreased risk. Risk factors associated with early psychosocial withdrawals were underweight and higher socioeconomic status. Presence of peripheral vascular disease, chronic lung disease and cancers were associated with early medical withdrawals.
CONCLUSIONS
Death from dialysis withdrawal accounted for >30% of early deaths in kidney failure patients initiated on dialysis and remained unchanged over the past two decades. Several shared risk factors were observed between mortality attributed to early psychosocial and medical withdrawals.

Identifiants

DOI: 10.1093/ndt/gfab207 PMID: 34175956 PMC: PMC8951200
pubmed: 34175956
pii: 6310179
doi: 10.1093/ndt/gfab207
pmc: PMC8951200
doi:

Types de publication

Journal Article

Langues

eng

Sous-ensembles de citation

IM

Pagination

760-769

Commentaires et corrections

Type : CommentIn
Type : ErratumIn

Informations de copyright

© The Author(s) 2021. Published by Oxford University Press on behalf of the ERA.

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Auteurs

Jenny H C Chen (JHC)

School of Medicine, University of Wollongong, Wollongong, Australia.
Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia.

Mark A Brown (MA)

Department of Nephrology, St George Hospital, Sydney, Australia.
School of Medicine, University of New South Wales, Sydney, Australia.

Matthew Jose (M)

School of Medicine, The University of Tasmania, Hobart, Australia.
Department of Nephrology, Royal Hobart Hospital, Hobart, Australia.

Frank Brennan (F)

Department of Nephrology, St George Hospital, Sydney, Australia.
School of Medicine, University of New South Wales, Sydney, Australia.

David W Johnson (DW)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
Centre for Health Services Research, University of Queensland, Brisbane, Australia.
Translational Research Institute, Brisbane, Australia.
Australasian Kidney Trials Network, Brisbane, Australia.

Matthew A Roberts (MA)

School of Medicine, Monash University, Melbourne, Australia.
Renal Service, Eastern Health, Melbourne, Australia.

Germaine Wong (G)

Sydney School of Public Health, University of Sydney, Sydney, Australia.
Centre for Kidney Research, The Children's Hospital at Westmead, Westmead, Australia.
Centre for Transplant and Renal Research, Westmead Hospital, Westmead, Australia.

Hicham Cheikh Hassan (H)

School of Medicine, University of Wollongong, Wollongong, Australia.
Depatment of Renal Medicine, Wollongong Hospital, Wollongong, Australia.

Alice Kennard (A)

School of Medicine, Australian National University, Canberra, Australia.
Department of Nephrology, Canberra Hospital, Canberra, Australia.

Rachael Walker (R)

Sydney School of Public Health, University of Sydney, Sydney, Australia.
School of Nursing, Eastern Institute of Technology, Napier, New Zealand.

Christopher E Davies (CE)

Australia and New Zealand Dialysis and Transplant Registry, South Australian Health and Medical Research Institute, Adelaide, Australia.
Adelaide Medical School, University of Adelaide, Adelaide, Australia.

Neil Boudville (N)

Medical School, University of Western Australia, Perth, Australia.
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.

Monique Borlace (M)

Central Northern Adelaide Renal and Transplantation Service, Royal Adelaide Hospital, Adelaide, Australia.

Carmel Hawley (C)

Department of Nephrology, Princess Alexandra Hospital, Brisbane, Australia.
Centre for Health Services Research, University of Queensland, Brisbane, Australia.
Translational Research Institute, Brisbane, Australia.
Australasian Kidney Trials Network, Brisbane, Australia.

Wai H Lim (WH)

Medical School, University of Western Australia, Perth, Australia.
Department of Renal Medicine, Sir Charles Gairdner Hospital, Perth, Australia.

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questionsmedicales.fr › Personnes › Tranches d'âge › Adulte › Temporal changes and risk factors for death...
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