First-year mortality in incident dialysis patients: results of the Peridialysis study

James Heaf (Coresponding Author), Maija Heiro, Aivars Petersons, Baiba Vernere, Johan V Povlsen, Anette Bagger Sørensen, Naomi Clyne, Inga Bumblyte, Alanta Zilinskiene, Else Randers, Niels Løkkegaard, Mai Rosenberg, Stig Kjellevold, Jan Dominik Kampmann, Björn Rogland, Inger Lagreid, Olof Heimburger, Bengt Lindholm

Research output: Working paperPreprint

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Abstract

Background: Controversy surrounds which factors are important for predicting early mortality after dialysis initiation (DI). We investigated associations of predialysis course and circumstances affecting planning and execution of DI with mortality following DI.

Methods: Among 1580 patients participating in the Peridialysis study, a prospective study of causes and timing of DI, features of predialysis course, clinical and biochemical data at DI, incidence of unplanned suboptimal DI, contraindications to peritoneal dialysis (PD) or hemodialysis (HD), and modality preference, actual choice, and cause of modality choice were registered. Patients were followed for 12 months or until transplantation.

Results: First-year mortality was 20.2%. In addition to age and comorbid factors, independent factors predicting death were: clinical contraindications to PD or HD, a rapidly falling eGFR before DI, suboptimal DI, acidosis, high C-reactive protein, signs of overhydration (pulmonary stasis) and cerebral symptoms at DI while eGFR at DI was not. Among 1061 (67.2%) patients who could select dialysis modality based on personal choice, 654 (61.6%) chose PD, 368 (34.7%) center HD and 39 (3.7%) home HD. The 12-months survival did not differ significantly between patients receiving PD and in-center HD.

Conclusions: First-year mortality in incident dialysis patients was associated with high age, comorbidity, worsening of kidney failure and clinical symptoms, acidosis, inflammation, and suboptimal DI while eGFR at DI and dialysis modality did not appear as predictors. These findings support the view that choice of dialysis modality among patients who are able to make an informed decision can be based on patient preference.

Original languageEnglish
PublisherResearch Square
Number of pages24
DOIs
Publication statusPublished - 15 Apr 2021
Externally publishedYes

Field of Science*

  • 3.2 Clinical medicine

Publication Type*

  • 6. Other publications

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