Survival and dialysis initiation

comparing British Columbia and Scotland registries

Simon Sawhney, Ognjenka Djurdjev, Keith Simpson, Alison Murray MacLeod, Adeera Levin

Research output: Contribution to journalArticle

67 Citations (Scopus)

Abstract

Background. Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.

Methods. This study compares dialysis survival in two geographically similar areas, Scotland and British Columbia, Canada (BC). The effect of eGFR at dialysis start on survival was also measured. Incident adult dialysis populations of Scotland (n = 3372) and BC (n = 3927), 2000-05 were compared. Mortality Hazard ratios (HR) were calculated using a Cox proportional hazards model. Multivariate analysis included pre-dialysis eGFR, registry, age, sex, dialysis modality, year of start, pre-dialysis haemoglobin and primary renal diagnosis.

Results. Median survival times from start of dialysis were 38 (35-40) and 44 (42-47) months in Scotland and BC, respectively, giving an unadjusted mortality HR, Scotland versus BC, of 1.20 (95% C.I. 1.12-1.29). BC patients started dialysis at a higher eGFR (8.9 ml/min/1.73 m(2)) than Scotland (7.5 ml/min/1.73 m(2)), and prior to modelling higher starting eGFR was associated with higher mortality (1 ml/min/1.73 m(2) increase, HR = 1.028; 95% C.I. 1.021-1.035). BC patients were also older and had more diabetic renal disease. In multivariate analysis, lower starting eGFR was associated with better survival, and Scotland had greater mortality than BC. General population mortality and transplantation rate had only minor influence.

Conclusions. Concepts of 'late' versus 'early' start dialysis based on eGFR alone may need modification given the complexity and confounding reasons for dialysis initiation.

Original languageEnglish
Pages (from-to)3186-3192
Number of pages7
JournalNephrology Dialysis Transplantation
Volume24
Issue number10
Early online date23 Apr 2009
DOIs
Publication statusPublished - Oct 2009

Keywords

  • chronic kidney disease
  • dialysis initiation
  • eGFR
  • incident patients
  • survival
  • renal replacement therapy
  • mortality
  • comorbidity
  • failure

Cite this

Survival and dialysis initiation : comparing British Columbia and Scotland registries. / Sawhney, Simon; Djurdjev, Ognjenka; Simpson, Keith; MacLeod, Alison Murray; Levin, Adeera.

In: Nephrology Dialysis Transplantation, Vol. 24, No. 10, 10.2009, p. 3186-3192.

Research output: Contribution to journalArticle

Sawhney, Simon ; Djurdjev, Ognjenka ; Simpson, Keith ; MacLeod, Alison Murray ; Levin, Adeera. / Survival and dialysis initiation : comparing British Columbia and Scotland registries. In: Nephrology Dialysis Transplantation. 2009 ; Vol. 24, No. 10. pp. 3186-3192.
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abstract = "Background. Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.Methods. This study compares dialysis survival in two geographically similar areas, Scotland and British Columbia, Canada (BC). The effect of eGFR at dialysis start on survival was also measured. Incident adult dialysis populations of Scotland (n = 3372) and BC (n = 3927), 2000-05 were compared. Mortality Hazard ratios (HR) were calculated using a Cox proportional hazards model. Multivariate analysis included pre-dialysis eGFR, registry, age, sex, dialysis modality, year of start, pre-dialysis haemoglobin and primary renal diagnosis.Results. Median survival times from start of dialysis were 38 (35-40) and 44 (42-47) months in Scotland and BC, respectively, giving an unadjusted mortality HR, Scotland versus BC, of 1.20 (95{\%} C.I. 1.12-1.29). BC patients started dialysis at a higher eGFR (8.9 ml/min/1.73 m(2)) than Scotland (7.5 ml/min/1.73 m(2)), and prior to modelling higher starting eGFR was associated with higher mortality (1 ml/min/1.73 m(2) increase, HR = 1.028; 95{\%} C.I. 1.021-1.035). BC patients were also older and had more diabetic renal disease. In multivariate analysis, lower starting eGFR was associated with better survival, and Scotland had greater mortality than BC. General population mortality and transplantation rate had only minor influence.Conclusions. Concepts of 'late' versus 'early' start dialysis based on eGFR alone may need modification given the complexity and confounding reasons for dialysis initiation.",
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T2 - comparing British Columbia and Scotland registries

AU - Sawhney, Simon

AU - Djurdjev, Ognjenka

AU - Simpson, Keith

AU - MacLeod, Alison Murray

AU - Levin, Adeera

PY - 2009/10

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N2 - Background. Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.Methods. This study compares dialysis survival in two geographically similar areas, Scotland and British Columbia, Canada (BC). The effect of eGFR at dialysis start on survival was also measured. Incident adult dialysis populations of Scotland (n = 3372) and BC (n = 3927), 2000-05 were compared. Mortality Hazard ratios (HR) were calculated using a Cox proportional hazards model. Multivariate analysis included pre-dialysis eGFR, registry, age, sex, dialysis modality, year of start, pre-dialysis haemoglobin and primary renal diagnosis.Results. Median survival times from start of dialysis were 38 (35-40) and 44 (42-47) months in Scotland and BC, respectively, giving an unadjusted mortality HR, Scotland versus BC, of 1.20 (95% C.I. 1.12-1.29). BC patients started dialysis at a higher eGFR (8.9 ml/min/1.73 m(2)) than Scotland (7.5 ml/min/1.73 m(2)), and prior to modelling higher starting eGFR was associated with higher mortality (1 ml/min/1.73 m(2) increase, HR = 1.028; 95% C.I. 1.021-1.035). BC patients were also older and had more diabetic renal disease. In multivariate analysis, lower starting eGFR was associated with better survival, and Scotland had greater mortality than BC. General population mortality and transplantation rate had only minor influence.Conclusions. Concepts of 'late' versus 'early' start dialysis based on eGFR alone may need modification given the complexity and confounding reasons for dialysis initiation.

AB - Background. Outcomes are a major metric for evaluating effectiveness of dialysis. Comparisons between different populations reveal significant variation. In addition, the question of optimal timing of dialysis start lacks robust data from which to generate conclusions.Methods. This study compares dialysis survival in two geographically similar areas, Scotland and British Columbia, Canada (BC). The effect of eGFR at dialysis start on survival was also measured. Incident adult dialysis populations of Scotland (n = 3372) and BC (n = 3927), 2000-05 were compared. Mortality Hazard ratios (HR) were calculated using a Cox proportional hazards model. Multivariate analysis included pre-dialysis eGFR, registry, age, sex, dialysis modality, year of start, pre-dialysis haemoglobin and primary renal diagnosis.Results. Median survival times from start of dialysis were 38 (35-40) and 44 (42-47) months in Scotland and BC, respectively, giving an unadjusted mortality HR, Scotland versus BC, of 1.20 (95% C.I. 1.12-1.29). BC patients started dialysis at a higher eGFR (8.9 ml/min/1.73 m(2)) than Scotland (7.5 ml/min/1.73 m(2)), and prior to modelling higher starting eGFR was associated with higher mortality (1 ml/min/1.73 m(2) increase, HR = 1.028; 95% C.I. 1.021-1.035). BC patients were also older and had more diabetic renal disease. In multivariate analysis, lower starting eGFR was associated with better survival, and Scotland had greater mortality than BC. General population mortality and transplantation rate had only minor influence.Conclusions. Concepts of 'late' versus 'early' start dialysis based on eGFR alone may need modification given the complexity and confounding reasons for dialysis initiation.

KW - chronic kidney disease

KW - dialysis initiation

KW - eGFR

KW - incident patients

KW - survival

KW - renal replacement therapy

KW - mortality

KW - comorbidity

KW - failure

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DO - 10.1093/ndt/gfp189

M3 - Article

VL - 24

SP - 3186

EP - 3192

JO - Nephrology Dialysis Transplantation

JF - Nephrology Dialysis Transplantation

SN - 0931-0509

IS - 10

ER -