Initial Glomerular Filtration Rate and Survival in Hemodialysis: the role of permanent vascular access
Background: A significant increase in the number of patients starting chronic hemodialysis (HD) with an estimated glomerular filtration rate (eGFR)≥10mL/min/1.73m² was observed in Argentina between 2004 and 2009. Methods: In order to study this topic, we calculated the mortality hazard ratios (HR) in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis [Registro Argentino de Diálisis Crónica] (2004-2009), grouped according to the initial eGFR (0-4.9, 5-9.9, 10-14.9 and ≥15mL/min/1.73m² ; reference group 0-4.9) estimated by CKD-EPI; in three cohorts: "total population", "healthy (<65 years, without diabetes or comorbidities) and "planned entry" (with permanent vascular access). Results: After adjusting the population (n=16,931) for age, gender, coexisting conditions, serum albumin, income, and temporary vascular access a HR of 1.19 (95%CI:1.07-1.33) was observed in the group with eGFR≥15mL/min/1.73m². In the cohort of 3,897 "healthy" after adjusting for the same co-variates, HRs of 1.44 (95%CI: 1.08-1.65) and 1.65 (95%CI: 1.06-2.55) were obtained for the groups with baseline eGFR values of 10-14.9 and ≥15mL/min/1.73m², respectively. In "planned entry" patients (n=6,280), after adjusting for age, gender, co-morbidities, serum albumin and income, HRs in all groups were not significantly different as compared to the control group. Conclusions: HD initiation with eGFR>10mL/min/1.73m² shows no survival advantage. The higher mortality in the group with >eGFR starting dialysis looks like an "artifact" related to higher age, more co-morbidities, low albuminemia and the use of temporary vascular access.
| Main Authors: | , , , , , , |
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| Format: | Digital revista |
| Language: | English |
| Published: |
Sociedad Española de Nefrología
2014
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| Online Access: | http://scielo.isciii.es/scielo.php?script=sci_arttext&pid=S0211-69952014000100010 |
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