Impact of timing of initiation of dialysis on long‑term prognosis of patients undergoing hemodialysis

Zhang,Yumei; Hu,Chun; Bian,Zhixiang; Chen,Peihua

doi:10.3892/etm.2018.6281

Impact of timing of initiation of dialysis on long‑term prognosis of patients undergoing hemodialysis

Authors:
- Yumei Zhang
- Chun Hu
- Zhixiang Bian
- Peihua Chen
View Affiliations

Affiliations: Division of Nephrology, Shanghai Ninth People's Hospital Affiliated to Shanghai Jiaotong University School of Medicine, Shanghai 201900, P.R. China
Published online on: June 8, 2018 https://doi.org/10.3892/etm.2018.6281
Pages: 1209-1215
Copyright: © Zhang et al. This is an open access article distributed under the terms of Creative Commons Attribution License.

Metrics: Total Views: 0 (Spandidos Publications: | PMC Statistics: )

Metrics: Total PDF Downloads: 0 (Spandidos Publications: | PMC Statistics: )

Cited By (CrossRef): 0 citations Loading Articles...

Abstract

There are a lot of controversies pertaining to correctness of timing for the initiation of dialysis in chronic kidney disease (CKD) patients. The present study was conducted to examine the potential association of initiation timing of dialyses with long‑term prognosis in CKD patients. In total, 294 patients confirmed as end‑stage renal disease (ESRD) were included as study subjects. According to the estimated glomerular filtration rate (eGFR) at initiation time, the patients were classified into four groups based on eGFR: ≥10.5, 8‑10.4, 6‑8 and <6 ml/min x (1.73 m2)‑1. The primary outcomes were defined by all‑cause mortality. The median eGFR of the 294 patients at initiation time was 5.43 (2.27‑13.92) ml/min x (1.73 m2)‑1. The patients with lower eGFR at the start of hemodialysis had a higher proportion of Charlson comorbidity index (CCI) scores of 0‑2 and had lower hematocrit. The multivariate Cox regression analysis indicated that CCI, cerebrovascular diseases and chronic obstructive pulmonary disease were significantly associated with all‑cause mortality, but not eGFR at the dialysis initiation. Furthermore, stratified analyses confirmed elevated eGFR that had no advantage on long‑term prognosis. The present findings have shown that the prevalence of anemia, hyperuricemia and calcium and phosphorus metabolism disorders of patients with low eGFRs at the initiation of hemodialysis was higher in comparison to the patients with high eGFRs. Therefore, the long‑term prognosis of patients with high eGFRs prior to hemodialysis was not improved.

View Figures

View References

1	Zhang QL and Rothenbacher D: Prevalence of chronic kidney disease in population-based studies: Systematic review. BMC Public Health. 8:1172008. View Article : Google Scholar : PubMed/NCBI
2	Faust J and Schreiner O: Early versus late initiation of dialysis. N Engl J Med. 363:2368–2369. 2010. View Article : Google Scholar : PubMed/NCBI
3	U.S. Renal Data System: USRDS 2009 annual data report: Atlas of chronic kidney disease and end-stage renal disease in the United StatesNational Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases. Bethesda, MD: 2009
4	Rosansky S, Glassock RJ and Clark WF: Early start of dialysis: A critical review. Clin J Am Soc Nephrol. 6:1222–1228. 2011. View Article : Google Scholar : PubMed/NCBI
5	Stel VS, Dekker FW, Ansell D, Augustijn H, Casino FG, Collart F, Finne P, Ioannidis GA, Salomone M, Traynor JP, et al: Residual renal function at the start of dialysis and clinical outcomes. Nephrol Dial Transplant. 24:3175–3182. 2009. View Article : Google Scholar : PubMed/NCBI
6	Liberek T, Warzocha A, Galgowska J, Taszner K, Clark WF and Rutkowski B: When to initiate dialysis-is early start always better? Nephrol Dial Transplant. 26:2087–2091. 2011. View Article : Google Scholar : PubMed/NCBI
7	Crews DC, Scialla JJ, Liu J, Guo H, Bandeen-Roche K, Ephraim PL, Jaar BG, Sozio SM, Miskulin DC, Tangri N, et al: Developing evidence to inform decisions about effectiveness (DEcIDE) patient outcomes in end stage renal dsease study investigators: Predialysis health, dialysis timing, and outcomes among older United States adults. J Am Soc Nephrol. 25:370–379. 2014. View Article : Google Scholar : PubMed/NCBI
8	Susantitaphong P, Altamimi S, Ashkar M, Balk EM, Stel VS, Wright S and Jaber BL: GFR at initiation of dialysis and mortality in CKD: A meta-analysis. Am J Kidney Dis. 59:829–840. 2012. View Article : Google Scholar : PubMed/NCBI
9	Rosansky SJ and Clark WF: Has the yearly increase in the renal replacement therapy population ended? J Am Soc Nephrol. 24:1367–1370. 2013. View Article : Google Scholar : PubMed/NCBI
10	Sawhney S, Djurdjev O, Simpson K, Macleod A and Levin A: Survival and dialysis initiation: Comparing British Columbia and Scotland registries. Nephrol Dial Transplant. 24:3186–3192. 2009. View Article : Google Scholar : PubMed/NCBI
11	Cooper BA, Branley P, Bulfone L, Collins JF, Craig JC, Fraenkel MB, Harris A, Johnson DW, Kesselhut J, Li JJ, et al: Ideal study: A randomized, controlled trial of early versus late initiation of dialysis. N Engl J Med. 363:609–619. 2010. View Article : Google Scholar : PubMed/NCBI
12	Clark WF, Na Y, Rosansky SJ, Sontrop JM, Macnab JJ, Glassock RJ, Eggers PW, Jackson K and Moist L: Association between estimated glomerular filtration rate at initiation of dialysis and mortality. CMAJ. 183:47–53. 2011. View Article : Google Scholar : PubMed/NCBI
13	Evans M, Tettamanti G, Nyrén O, Bellocco R, Fored CM and Elinder CG: No survival benefit from early-start dialysis in a population-based, inception cohort study of Swedish patients with chronic kidney disease. J Intern Med. 269:289–298. 2011. View Article : Google Scholar : PubMed/NCBI
14	Pan Y, Xu XD, Guo LL, Cai LL and Jin HM: Association of early versus late initiation of dialysis with mortality: Systematic review and meta-analysis. Nephron Clin Pract. 120:121–131. 2012. View Article : Google Scholar
15	Liu H, Peng Y, Liu F, Xiao H, Chen X, Huang A and Liu Y: Renal function and serum albumin at the start of dialysis in 514 Chinese ESRD in-patients. Ren Fail. 30:685–690. 2008. View Article : Google Scholar : PubMed/NCBI
16	Liebman SE, Bushinsky DA, Dolan JG and Veazie P: Differences between dialysis modality selection and initiation. Am J Kidney Dis. 59:550–557. 2012. View Article : Google Scholar : PubMed/NCBI
17	Kim SG and Kim NH: The effect of residual renal function at the initiation of dialysis on patient survival. Korean J Intern Med. 24:55–62. 2009. View Article : Google Scholar : PubMed/NCBI
18	Zhang M, Wang M, Li H, Yu P, Yuan L, Hao C, Chen J and Kalantar-Zadeh K: Association of initial twice-weekly hemodialysis treatment with preservation of residual kidney function in ESRD patients. Am J Nephrol. 40:140–150. 2014. View Article : Google Scholar : PubMed/NCBI
19	Lemes HP, Araujo S, Nascimento D, Cunha D, Garcia C, Queiroz V and Ferreira-Filho SR: Use of small doses of furosemide in chronic kidney disease patients with residual renal function undergoing hemodialysis. Clin Exp Nephrol. 15:554–559. 2011. View Article : Google Scholar : PubMed/NCBI
20	Orasan RA, Patiu IM, Anghel D, Bejan C, Iosub L, Totolici C, Pop M, Turcea C, Teodoru C, Orasan OH, et al: Variation of clinical and laboratory features in chronic dialysis patients treated with high-flux hemodialysis after switching to online hemodiafiltration. Int Urol Nephrol. 45:1415–1422. 2013. View Article : Google Scholar : PubMed/NCBI
21	Mehrotra R, Duong U, Jiwakanon S, Kovesdy CP, Moran J, Kopple JD and Kalantar-Zadeh K: Serum albumin as a predictor of mortality in peritoneal dialysis: Comparisons with hemodialysis. Am J Kidney Dis. 58:418–428. 2011. View Article : Google Scholar : PubMed/NCBI
22	Nguyen DB, Lessa FC, Belflower R, Mu Y, Wise M, Nadle J, Bamberg WM, Petit S, Ray SM, Harrison LH, et al: Active bacterial core surveillance (ABCs) MRSA investigators of the emerging infections program: Invasive methicillin-resistant Staphylococcus aureus infections among patients on chronic dialysis in the United States, 2005–2011. Clin Infect Dis. 57:1393–1400. 2013. View Article : Google Scholar : PubMed/NCBI
23	Grootendorst DC, Michels WM, Richardson JD, Jager KJ, Boeschoten EW, Dekker FW and Krediet RT: NECOSAD study group: The MDRD formula does not reflect GFR in ESRD patients. Nephrol Dial Transplant. 26:1932–1937. 2011. View Article : Google Scholar : PubMed/NCBI
24	Oh KH, Hwang YH, Cho JH, Kim M, Ju KD, Joo KW, Kim DK, Kim YS, Ahn C and Oh YK: Outcome of early initiation of peritoneal dialysis in patients with end-stage renal failure. J Korean Med Sci. 27:170–176. 2012. View Article : Google Scholar : PubMed/NCBI
25	Lassalle M, Labeeuw M, Frimat L, Villar E, Joyeux V, Couchoud C and Stengel B: Age and comorbidity may explain the paradoxical association of an early dialysis start with poor survival. Kidney Int. 77:700–707. 2010. View Article : Google Scholar : PubMed/NCBI
26	Kazmi WH, Gilbertson DT, Obrador GT, Guo H, Pereira BJ, Collins AJ and Kausz AT: Effect of comorbidity on the increased mortality associated with early initiation of dialysis. Am J Kidney Dis. 46:887–896. 2005. View Article : Google Scholar : PubMed/NCBI
27	Beddhu S, Samore MH, Roberts MS, Stoddard GJ, Ramkumar N, Pappas LM and Cheung AK: Impact of timing of initiation of dialysis on mortality. J Am Soc Nephrol. 14:2305–2312. 2003. View Article : Google Scholar : PubMed/NCBI
28	Crews DC, Scialla JJ, Boulware LE, Navaneethan SD, Nally JV Jr, Liu X, Arrigain S, Schold JD, Ephraim PL, Jolly SE, et al: DEcIDE Network Patient Outcomes in End Stage Renal Disease Study Investigators: Comparative effectiveness of early versus conventional timing of dialysis initiation in advanced CKD. Am J Kidney Dis. 63:806–815. 2014. View Article : Google Scholar : PubMed/NCBI