Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort

Satoshi Higuchi, Izaya Nakaya, Kazuhiro Yoshikawa, Yoichiro Chikamatsu, Kenei Sada, Suguru Yamamoto, Satoko Takahashi, Hiroyo Sasaki, Jun Soma

Research output: Contribution to journalArticle

2 Citations (Scopus)

Abstract

Introduction Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome. Methods We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model. Results The median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036). Discussion A longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.

Original languageEnglish
Pages (from-to)594-602
Number of pages9
JournalPropulsion and Power Research
Volume6
Issue number2
DOIs
Publication statusPublished - Jun 1 2017

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Hazards
Hematinics
Catheters

Keywords

  • all-cause mortality
  • cardiovascular event
  • estimated glomerular filtration rate
  • hemodialysis-free interval
  • nephrology care
  • performance status

ASJC Scopus subject areas

  • Aerospace Engineering
  • Mechanical Engineering
  • Fluid Flow and Transfer Processes
  • Fuel Technology
  • Automotive Engineering

Cite this

Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort. / Higuchi, Satoshi; Nakaya, Izaya; Yoshikawa, Kazuhiro; Chikamatsu, Yoichiro; Sada, Kenei; Yamamoto, Suguru; Takahashi, Satoko; Sasaki, Hiroyo; Soma, Jun.

In: Propulsion and Power Research, Vol. 6, No. 2, 01.06.2017, p. 594-602.

Research output: Contribution to journalArticle

Higuchi, S, Nakaya, I, Yoshikawa, K, Chikamatsu, Y, Sada, K, Yamamoto, S, Takahashi, S, Sasaki, H & Soma, J 2017, 'Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort', Propulsion and Power Research, vol. 6, no. 2, pp. 594-602. https://doi.org/10.1016/j.ekir.2017.01.015
Higuchi, Satoshi ; Nakaya, Izaya ; Yoshikawa, Kazuhiro ; Chikamatsu, Yoichiro ; Sada, Kenei ; Yamamoto, Suguru ; Takahashi, Satoko ; Sasaki, Hiroyo ; Soma, Jun. / Potential Benefit Associated With Delaying Initiation of Hemodialysis in a Japanese Cohort. In: Propulsion and Power Research. 2017 ; Vol. 6, No. 2. pp. 594-602.
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AU - Nakaya, Izaya

AU - Yoshikawa, Kazuhiro

AU - Chikamatsu, Yoichiro

AU - Sada, Kenei

AU - Yamamoto, Suguru

AU - Takahashi, Satoko

AU - Sasaki, Hiroyo

AU - Soma, Jun

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N2 - Introduction Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome. Methods We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model. Results The median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036). Discussion A longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.

AB - Introduction Late referral to a nephrologist, the type of vascular access, nutritional status, and the estimated glomerular filtration rate (eGFR) at the start of hemodialysis (HD) have been reported as independent risk factors of survival for patients who begin HD. The aim of this study was to clarify the influence of the HD-free interval from the time of an eGFR of 10 ml/min per 1.73 m2 (IGFR10-HD) on patient outcome. Methods We enrolled 124 patients aged older than 20 years who had HD initiated in a general hospital. The predictive factor was the HD-free IGFR10-HD. The primary outcome was the relationship of the HD-free interval on death or the onset of a cardiovascular event. Survival analysis was performed using the Cox regression model. Results The median IGFR10-HD was 159 days (range: 2–1687 days). The median eGFR at the initiation of HD was 5.48 ml/min per 1.73 m2. Sixty-seven of 124 patients (54.0%) reached the primary outcome. Of these, 29 died and 38 experienced a cardiovascular event. In univariate analysis, older age, a history of cardiovascular disease, nephrologic care for <6 months, higher modified Charlson comorbidity index score, poor performance status, temporary catheter, edema, diabetic retinopathy, and nonuse of erythropoiesis-stimulating agent were statistically related to the primary outcome. The unadjusted hazard ratio per log-transformed IGFR10-HD was 0.393 (95% confidence interval [CI]; 0.244−0.635; P < 0.001) and the hazard ratio adjusted for confounding factors was 0.507 (95% CI: 0.267−0.956; P = 0.036). Discussion A longer HD-free IGFR10-HD was associated with a lower risk of death or a cardiovascular event. The interval could be considered an independent prognostic factor for outcomes in patients on HD.

KW - all-cause mortality

KW - cardiovascular event

KW - estimated glomerular filtration rate

KW - hemodialysis-free interval

KW - nephrology care

KW - performance status

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