NDT Advance Access originally published online on June 10, 2009
Nephrology Dialysis Transplantation 2009 24(10):3175-3182; doi:10.1093/ndt/gfp264
| ||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||||
Residual renal function at the start of dialysis and clinical outcomes
1 Department of Medical Informatics, ERA–EDTA Registry, Academic Medical Center, University of Amsterdam, Amsterdam 2 Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands 3 The UK Renal Registry, Southmead Hospital, Bristol, UK 4 Nederlandstalige Belgische Vereniging voor Nefrologie, Edegem, Belgium 5 Department of Nephrology, Ospedale ‘Madonna delle Grazie’ Matera, Italy 6 Department of Medicine, Hôpitaux Iris Sud, Brussels, Belgium 7 Finnish Registry for Kidney Diseases, Helsinki, Finland and Tampere School of Public Health, Tampere University, Finland 8 Hellenic Renal Registry, Board of Registry, Coordination and Control of RRT, General Hospital of Athens, Athens, Greece 9 UOA di Nefrologia e Dialisi ASL 8, Osp. Maggiore di Chieri, Italy 10 Scottish Renal Registry, Glasgow Royal Infirmary, Glasgow G4 0SF, UK 11 Registre de Malalts Renals de la Comunitat Valenciana, Direccion General de Salud Publica, Conselleria de Sanitat, Valencia, Spain 12 Nephrology and Dialysis Unit, G. Gaslini Institute, Genoa, Italy
Correspondence and offprint requests to: Vianda S. Stel; E-mail: v.s.stel{at}amc.uva.nl
 |
Abstract |
|---|
Background. This study evaluates the association between estimated GFR (eGFR) at the start of dialysis and mortality within Europe.
Methods. Renal registries participating in the ERA–EDTA Registry were asked to provide data on serum creatinine recorded 0–4 weeks before the start of dialysis in incident dialysis patients in 1999 and 2003. Within this cohort study, data were available in 11 472 patients from nine national or regional European renal registries. Cox regression analyses were performed to examine the association between GFR estimated by the four-variable MDRD equation (eGFR) and all-cause mortality, using a follow-up through 31 December 2005.
Results. In the 2003 data, the mean eGFR was 8.6 ml/min/1.73 m2. The unadjusted survival analyses showed that an increase in eGFR of 1 ml/min/1.73 m2 was associated with a higher mortality risk (HR = 1.03; 95% CI: 1.03–1.04) that remained similar after adjustment for age, gender, primary renal disease, treatment modality, country and comorbidity. The findings were consistent across gender, treatment modalities, geographical regions and time periods (2003 versus 1999), but the association between a higher eGFR at the start of dialysis and mortality was the strongest in the youngest age groups and in patients with glomerulonephritis. Analyses at centre level showed that a 10% increase in the percentage of patients starting dialysis at high eGFR levels (
10.5 ml/min) was associated with a 22% higher mortality risk (HR = 1.22; 95% CI: 1.18–1.26).
Conclusions. This European study showed that a higher eGFR at the start of dialysis was associated with a higher mortality risk. However, an answer to the question when to start dialysis needs to come from randomized controlled trials.
Keywords: dialysis; epidemiology; Europe; residual renal function; survival
Received for publication: 5. 2.09
Accepted in revised form: 11. 5.09
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  T. Liberek, A. Warzocha, M. Chmielewski, and B. Rutkowski Initiation of dialysis--the right timing and the right tools Nephrol. Dial. Transplant., December 1, 2009; 24(12): 3895 - 3896. [Full Text] [PDF]
|
|
|
|
|
|
J. Tattersall Is it really better to start dialysis as late as possible? Nephrol. Dial. Transplant., October 1, 2009; 24(10): 2972 - 2974. [Full Text] [PDF]
|
|