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Association between a High Variability of Renal Function in the Predialysis Stage and the Dialysis Mortality Rate
並列摘要
BACKGOUND: This study examined the association between the variability of renal function in predialysis stage and the mortality rate after dialysis. METHODS: Adult patients who initiated hemodialysis in Taoyuan General Hospital from September, 2010 to October, 2015 were enrolled. We reviewed their clinical characteristics and biochemical data from the time of presentation to nephrologist to just before the time of commencing dialysis, and then followed them over a 5-year period after dialysis. The different degrees of variability of renal function were stratified according to tertiles of the median of the coefficient of variation (CV) in estimated glomerular filtration rate (eGFR) (low variability: 14; intermediate variability: 23; high variabaility: 43). Rapid kidney function decline (RKFD) was defined as an absolute annual decline of estimated glomerular filtration rate (eGFR) ＞ 5 mL/min/1.73 m^2. Adjusted hazard ratios (AHRs) for mortality and cumulative survival curves were evaluated by the Cox proportional hazard model and the Kaplan-Meier method. We also calculated the area under the curve (AUC) and the receiver operating characteristic curve (ROC) for them. RESULTS: From a total of 275 hemodialysis patients, most (96.1%) of the subjects were referred to the study with advanced chronic kidney disease (stage 4 and stage 5). The slope and variability of eGFR is greater in the high eGFR variability group than those in the low eGFR variability group (-5.41 mL/ min/1.73 m^2/yr vs. -2.02 mL/min/1.73 m^2/yr and 43 unit vs. 14 unit, P ＜ 0.001). Besides old age and RKFD, high eGFR variability was also significantly associated with dialysis mortality after multivariate adjustment. Compared to the low eGFR variability group, the AHR and the 95% confidence interval (CI) of the high eGFR variability group were 1.928 (1.041 ~ 4.422) (P = 0.021). The AUC of the ROC for the different subgroups were as followed: all subjects: 0.613 (0.543 ~ 0.684); those with other organ failure: 0.656 (0.571 ~ 0.741); those without RKFD: 0.618 (0.538 ~ 0.698); those older than 65 years old: 0.678 (0.580 ~ 0.776) (P ＜ 0.001 only in subjects with other organ failure, and those aged 65 and above. CONCLUSION: In those on chronic dialysis, high predialytic eGFR variability was associated with a high dialysis mortality rate, especially in those with other organ failure and those older 65 years old without predialytic RKFD.
延伸閱讀
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