Predialysis health, dialysis timing, and outcomes among older United States adults

Deidra C. Crews, Julia J. Scialla, Jiannong Liu, Haifeng Guo, Karen Bandeen-Roche, Patti L. Ephraim, Bernard G. Jaar, Stephen M. Sozio, Dana C. Miskulin, Navdeep Tangri, Tariq Shafi, Klemens B. Meyer, Albert W. Wu, Neil R. Powe, L. Ebony Boulware

Research output: Contribution to journalArticle

57 Citations (Scopus)

Abstract

Studies of dialysis initiation timing have not accounted for predialysis clinical factors that could impact postdialysis outcomes. We examined the association of predialysis health with timing of dialysis initiation in older adult patients in the United States and contrasted morbidity and mortality outcomes among patients with early [estimated GFR (eGFR)≥10 ml/min per 1.73 m2] versus later (eGFR<10 ml/min per 1.73 m2) initiation. We included all patients from the US Renal Data System who initiated dialysis between 2006 and 2008, were ≥67 years old, and had ≥2 years of prior Medicare coverage (n=84,654). We calculated patients'propensity to initiate dialysis early and matched patients by propensity scores. Cox models were used to compare risks of mortality and hospitalization among initiation groups. The majority (58%) of patients initiated dialysis early. Early initiators were more likely to have had AKI, multiple congestive heart failure admissions, and other hospitalizations preceding initiation. Among propensity-matched patients (n=61,930), early initiation associated with greater allcause (hazard ratio [HR], 1.11; 95% confidence interval [95% CI], 1.08 to 1.14), cardiovascular (CV; HR, 1.13; 95% CI, 1.09 to 1.17), and infectious (HR, 1.13; 95% CI, 1.06 to 1.22) mortality and greater all-cause (HR, 1.03; 95% CI, 1.01 to 1.05) and infectious (HR, 1.10; 95% CI, 1.07 to 1.13) hospitalizations. There was no difference in CV hospitalizations. Among these older adults, early dialysis initiation associates with greater mortality and hospitalizations, even after accounting for predialysis clinical factors. These findings do not support the common practice of early dialysis initiation in the United States.

Original languageEnglish
Pages (from-to)370-379
Number of pages10
JournalJournal of the American Society of Nephrology
Volume25
Issue number2
DOIs
StatePublished - Feb 1 2014

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Dialysis
Hospitalization
Health
Confidence Intervals
Mortality
Propensity Score
Medicare
Proportional Hazards Models
Information Systems
Heart Failure
Morbidity
Kidney

ASJC Scopus subject areas

  • Nephrology

Cite this

Crews, D. C., Scialla, J. J., Liu, J., Guo, H., Bandeen-Roche, K., Ephraim, P. L., ... Boulware, L. E. (2014). Predialysis health, dialysis timing, and outcomes among older United States adults. Journal of the American Society of Nephrology, 25(2), 370-379. https://doi.org/10.1681/ASN.2013050567

Predialysis health, dialysis timing, and outcomes among older United States adults. / Crews, Deidra C.; Scialla, Julia J.; Liu, Jiannong; Guo, Haifeng; Bandeen-Roche, Karen; Ephraim, Patti L.; Jaar, Bernard G.; Sozio, Stephen M.; Miskulin, Dana C.; Tangri, Navdeep; Shafi, Tariq; Meyer, Klemens B.; Wu, Albert W.; Powe, Neil R.; Boulware, L. Ebony.

In: Journal of the American Society of Nephrology, Vol. 25, No. 2, 01.02.2014, p. 370-379.

Research output: Contribution to journalArticle

Crews, DC, Scialla, JJ, Liu, J, Guo, H, Bandeen-Roche, K, Ephraim, PL, Jaar, BG, Sozio, SM, Miskulin, DC, Tangri, N, Shafi, T, Meyer, KB, Wu, AW, Powe, NR & Boulware, LE 2014, 'Predialysis health, dialysis timing, and outcomes among older United States adults', Journal of the American Society of Nephrology, vol. 25, no. 2, pp. 370-379. https://doi.org/10.1681/ASN.2013050567
Crews, Deidra C. ; Scialla, Julia J. ; Liu, Jiannong ; Guo, Haifeng ; Bandeen-Roche, Karen ; Ephraim, Patti L. ; Jaar, Bernard G. ; Sozio, Stephen M. ; Miskulin, Dana C. ; Tangri, Navdeep ; Shafi, Tariq ; Meyer, Klemens B. ; Wu, Albert W. ; Powe, Neil R. ; Boulware, L. Ebony. / Predialysis health, dialysis timing, and outcomes among older United States adults. In: Journal of the American Society of Nephrology. 2014 ; Vol. 25, No. 2. pp. 370-379.
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