TY - JOUR
T1 - Comparative effectiveness of early versus conventional timing of dialysis initiation in advanced CKD
AU - Crews, Deidra C.
AU - Scialla, Julia J.
AU - Boulware, L. Ebony
AU - Navaneethan, Sankar D.
AU - Nally, Joseph V.
AU - Liu, Xiaobo
AU - Arrigain, Susana
AU - Schold, Jesse D.
AU - Ephraim, Patti L.
AU - Jolly, Stacey E.
AU - Sozio, Stephen M.
AU - Michels, Wieneke M.
AU - Miskulin, Dana C.
AU - Tangri, Navdeep
AU - Shafi, Tariq
AU - Wu, Albert W.
AU - Bandeen-Roche, Karen
N1 - Funding Information:
Support: The DEcIDE Network Patient Outcomes in ESRD Study was supported by the AHRQ contract HHSA290200500341I, task order 6. The creation of the CCF CKD registry was funded by an unrestricted grant from Amgen Inc to the Department of Nephrology and Hypertension Research and Education Fund . Dr Crews was supported by the Harold Amos Medical Faculty Development Program of the Robert Wood Johnson Foundation. Drs Jolly, Scialla, and Shafi were supported by grants from the NIDDK ( K23 DK091363 , K23 DK095949 , and K23 DK083514 , respectively). Dr Michels was supported by Postdoctoral Full Fellowship Abroad Grant (KFB 11.005) of the Dutch Kidney Foundation (Nierstichting).
PY - 2014/5
Y1 - 2014/5
N2 - Background Previous observational studies examining outcomes associated with the timing of dialysis therapy initiation in the United States have often been limited by lead time and survivor bias. Study Design Retrospective cohort study comparing the effectiveness of early versus later (conventional) dialysis therapy initiation in advanced chronic kidney disease (CKD). The analysis used inverse probability weighting to account for an individual's contribution to different exposure groups over time in a pooled logistic regression model. Patients contributed risk to both exposure categories (early and later initiation) until there was a clear treatment strategy (ie, dialysis therapy was initiated early or estimated glomerular filtration rate [eGFR] decreased to <10 mL/min/1.73 m2). Setting & Participants Patients with CKD who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider as of January 1, 2005, and at least 3 eGFRs in the range of 20-30 mL/min/1.73 m2 measured at least 180 days apart. Predictors Timing of dialysis therapy initiation as determined using model-based interpolation of eGFR trajectories over time. Timing was defined as early (interpolated eGFR at dialysis therapy initiation 10 mL/min/1.73 m2) or later (eGFR < 10 mL/min/1.73 m2) and was time-varying. Outcomes Death from any cause occurring from the time that eGFR was equal to 20 mL/min/1.73 m2 through September 15, 2009. Results The study population consisted of 652 patients meeting inclusion criteria. Most (71.3%) of the study population did not initiate dialysis therapy during follow-up. Patients who did not initiate dialysis therapy (n = 465) were older, more likely to be white, and had more favorable laboratory profiles than those who started dialysis therapy. Overall, 146 initiated dialysis early and 80 had eGFRs decrease to <10 mL/min/1.73 m2. Many participants (n = 426) were censored prior to attaining a clear treatment strategy and were considered undeclared. There was no statistically significant survival difference for the early compared with later initiation strategy (OR, 0.85; 95% CI, 0.65-1.11). Limitations Interpolated eGFR, moderate sample size, and likely unmeasured confounders. Conclusions In patients with advanced CKD, timing of dialysis therapy initiation was not associated with mortality when accounting for lead time bias and survivor bias.
AB - Background Previous observational studies examining outcomes associated with the timing of dialysis therapy initiation in the United States have often been limited by lead time and survivor bias. Study Design Retrospective cohort study comparing the effectiveness of early versus later (conventional) dialysis therapy initiation in advanced chronic kidney disease (CKD). The analysis used inverse probability weighting to account for an individual's contribution to different exposure groups over time in a pooled logistic regression model. Patients contributed risk to both exposure categories (early and later initiation) until there was a clear treatment strategy (ie, dialysis therapy was initiated early or estimated glomerular filtration rate [eGFR] decreased to <10 mL/min/1.73 m2). Setting & Participants Patients with CKD who had at least one face-to-face outpatient encounter with a Cleveland Clinic health care provider as of January 1, 2005, and at least 3 eGFRs in the range of 20-30 mL/min/1.73 m2 measured at least 180 days apart. Predictors Timing of dialysis therapy initiation as determined using model-based interpolation of eGFR trajectories over time. Timing was defined as early (interpolated eGFR at dialysis therapy initiation 10 mL/min/1.73 m2) or later (eGFR < 10 mL/min/1.73 m2) and was time-varying. Outcomes Death from any cause occurring from the time that eGFR was equal to 20 mL/min/1.73 m2 through September 15, 2009. Results The study population consisted of 652 patients meeting inclusion criteria. Most (71.3%) of the study population did not initiate dialysis therapy during follow-up. Patients who did not initiate dialysis therapy (n = 465) were older, more likely to be white, and had more favorable laboratory profiles than those who started dialysis therapy. Overall, 146 initiated dialysis early and 80 had eGFRs decrease to <10 mL/min/1.73 m2. Many participants (n = 426) were censored prior to attaining a clear treatment strategy and were considered undeclared. There was no statistically significant survival difference for the early compared with later initiation strategy (OR, 0.85; 95% CI, 0.65-1.11). Limitations Interpolated eGFR, moderate sample size, and likely unmeasured confounders. Conclusions In patients with advanced CKD, timing of dialysis therapy initiation was not associated with mortality when accounting for lead time bias and survivor bias.
KW - Index Words
KW - Kidney disease trajectory
KW - decreased glomerular filtration rate (GFR)
KW - dialysis initiation
KW - early-start dialysis
KW - end-stage renal disease (ESRD)
KW - prognosis
KW - renal disease progression
KW - renal replacement therapy (RRT)
KW - timing of dialysis
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U2 - 10.1053/j.ajkd.2013.12.010
DO - 10.1053/j.ajkd.2013.12.010
M3 - Article
C2 - 24508475
AN - SCOPUS:84898921803
SN - 0272-6386
VL - 63
SP - 806
EP - 815
JO - American Journal of Kidney Diseases
JF - American Journal of Kidney Diseases
IS - 5
ER -