TY - JOUR
T1 - Residual Kidney Function and Cause-Specific Mortality Among Incident Hemodialysis Patients
AU - Okazaki, Masaki
AU - Obi, Yoshitsugu
AU - Shafi, Tariq
AU - Rhee, Connie M.
AU - Kovesdy, Csaba P.
AU - Kalantar-Zadeh, Kamyar
N1 - Funding Information:
MO was supported by the Uehara Memorial Foundation Postdoctoral Fellowship. KKZ has been supported by the NIH/NIDDK mid-career award K24-DK091419. The funding bodies and others had no role in the study design, collection, analysis, and interpretation of data, writing of the report, or the decision to submit the report for publication.
Funding Information:
MO was supported by the Uehara Memorial Foundation Postdoctoral Fellowship. KKZ has been supported by the NIH/NIDDK mid-career award K24-DK091419. The funding bodies and others had no role in the study design, collection, analysis, and interpretation of data, writing of the report, or the decision to submit the report for publication. The data supporting the findings of this study are not publicly available due to containing information that could compromise the privacy of research participants. The corresponding author will detail the restrictions and conditions under which access to some data may be provided upon reasonable request. Research idea and study design was by MO, YO, TS, and KKZ; data acquisition was by MO; data analysis/interpretation were by MO, YO, TS, CMR, CPK and KKZ; statistical analysis was by MO, YO, and TS; supervision or mentorship was by YO, TS, and KKZ. Each author contributed important intellectual content during manuscript drafting or revision and agrees to be personally accountable for the author's own contributions and to ensure that questions pertaining to the accuracy or integrity of any portion of the work are appropriately investigated and resolved.
Publisher Copyright:
© 2023
PY - 2023/10
Y1 - 2023/10
N2 - Introduction: The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CLurea) with specific causes of death. Methods: We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CLurea and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis. Results: Among 39,623 patients with data on baseline renal CLurea and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model (Ptrend < 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CLurea and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CLurea showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD. Conclusion: Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.
AB - Introduction: The survival benefit of residual kidney function (RKF) in patients on hemodialysis is presumably due to enhanced fluid management and solute clearance. However, data are lacking on the association of renal urea clearance (CLurea) with specific causes of death. Methods: We conducted a longitudinal cohort study of 39,623 adults initiating thrice-weekly in-center hemodialysis from 2007 to 2011 and had data on renal CLurea and urine volume. Multivariable cause-specific proportional hazards model was used to examine the associations between baseline RKF and cause-specific mortality, including sudden cardiac death (SCD), non-SCD cardiovascular death (CVD), and non-CVD. Restricted cubic splines were fitted for change in RKF over 6 months after initiating hemodialysis. Results: Among 39,623 patients with data on baseline renal CLurea and urine volume, there was a significant trend toward a higher mortality risk across lower RKF levels, irrespective of cause of death in a case-mix adjustment model (Ptrend < 0.05). Adjustment for ultrafiltration rate (UFR) slightly attenuated the association between low renal CLurea and high cause-specific mortality, whereas adjustment for highest potassium did not have substantial effect. Among 12,169 patients with data on change in RKF, a 6-month decline in renal CLurea showed graded associations with SCD, non-SCD CVD, and non-CVD risk, whereas the graded associations between faster 6-month decline in urine output and higher death risk were clear only for SCD and non-CVD. Conclusion: Lower RKF and loss of RKF were associated with higher cause-specific mortality among patients initiating thrice-weekly in-center hemodialysis.
KW - hemodialysis
KW - non-cardiovascular death
KW - renal urea clearance
KW - residual kidney function
KW - sudden cardiac death
KW - ultrafiltration rate
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U2 - 10.1016/j.ekir.2023.07.020
DO - 10.1016/j.ekir.2023.07.020
M3 - Article
AN - SCOPUS:85169792743
SN - 2468-0249
VL - 8
SP - 1989
EP - 2000
JO - Kidney International Reports
JF - Kidney International Reports
IS - 10
ER -