Tags

Type your tag names separated by a space and hit enter

Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients.
Am J Kidney Dis. 2005 Dec; 46(6):1107-16.AJ

Abstract

BACKGROUND

Skipping hemodialysis treatments and failing to adhere to prescribed diets are thought to injure hemodialysis patients.

METHODS

We examined predictors of hemodialysis skipping and laboratory measures of nonadherence and then examined the association of dialysis skipping and serum potassium and phosphate levels with survival.

RESULTS

Of 739 patients, 67 were classified as skippers because they were absent for greater than 3% of scheduled treatments. Black race (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.30 to 3.92), current smoking (OR, 1.79; 95% CI, 1.02 to 3.13), and use of illicit drugs (OR, 3.96; 95% CI, 2.16 to 7.24) were associated with skipping. White race, increased serum phosphate level, greater creatinine level, and lower body mass index increased the likelihood of a serum potassium level greater than 5.0 mEq/L (mmol/L); younger age, greater serum potassium level, and greater serum creatinine level were associated with a serum phosphate level greater than 5.5 mg/dL (>1.78 mmol/L). Skipping was associated with an increased risk for death (hazard ratio [HR], 1.69; 95% CI, 1.24 to 2.31), as were phosphate level greater than 5.5 mg/dL (HR, 1.59; 95% CI, 1.16 to 2.17) and potassium level greater than 5.0 mEq/L (HR, 1.50; 95% CI, 1.10 to 2.06). Skipping was associated with a lower likelihood of kidney transplantation in those younger than 65 years (OR, 0.41; 95% CI, 0.18 to 0.93).

CONCLUSION

These findings show that hemodialysis patients of black race and those with current tobacco or illicit drug use are at risk for skipping dialysis treatments. Skipping treatments and markers of poor dietary adherence are strongly associated with greater risk for death. Targeting high-risk patients to understand reasons for nonadherence and to intervene could prevent premature death.

Authors+Show Affiliations

Renal-Electrolyte Division, Epidemiology Data Center, University of Pittsburgh Medical Center, Pittsburgh, PA 15261, USA. unruh@pitt.eduNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study
Research Support, N.I.H., Extramural
Research Support, Non-U.S. Gov't
Research Support, U.S. Gov't, P.H.S.

Language

eng

PubMed ID

16310577

Citation

Unruh, Mark L., et al. "Skipped Treatments, Markers of Nutritional Nonadherence, and Survival Among Incident Hemodialysis Patients." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 46, no. 6, 2005, pp. 1107-16.
Unruh ML, Evans IV, Fink NE, et al. Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. Am J Kidney Dis. 2005;46(6):1107-16.
Unruh, M. L., Evans, I. V., Fink, N. E., Powe, N. R., & Meyer, K. B. (2005). Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 46(6), 1107-16.
Unruh ML, et al. Skipped Treatments, Markers of Nutritional Nonadherence, and Survival Among Incident Hemodialysis Patients. Am J Kidney Dis. 2005;46(6):1107-16. PubMed PMID: 16310577.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Skipped treatments, markers of nutritional nonadherence, and survival among incident hemodialysis patients. AU - Unruh,Mark L, AU - Evans,Idris V, AU - Fink,Nancy E, AU - Powe,Neil R, AU - Meyer,Klemens B, AU - ,, PY - 2005/07/19/received PY - 2005/09/07/accepted PY - 2005/11/29/pubmed PY - 2006/2/4/medline PY - 2005/11/29/entrez SP - 1107 EP - 16 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 46 IS - 6 N2 - BACKGROUND: Skipping hemodialysis treatments and failing to adhere to prescribed diets are thought to injure hemodialysis patients. METHODS: We examined predictors of hemodialysis skipping and laboratory measures of nonadherence and then examined the association of dialysis skipping and serum potassium and phosphate levels with survival. RESULTS: Of 739 patients, 67 were classified as skippers because they were absent for greater than 3% of scheduled treatments. Black race (odds ratio [OR], 2.26; 95% confidence interval [CI], 1.30 to 3.92), current smoking (OR, 1.79; 95% CI, 1.02 to 3.13), and use of illicit drugs (OR, 3.96; 95% CI, 2.16 to 7.24) were associated with skipping. White race, increased serum phosphate level, greater creatinine level, and lower body mass index increased the likelihood of a serum potassium level greater than 5.0 mEq/L (mmol/L); younger age, greater serum potassium level, and greater serum creatinine level were associated with a serum phosphate level greater than 5.5 mg/dL (>1.78 mmol/L). Skipping was associated with an increased risk for death (hazard ratio [HR], 1.69; 95% CI, 1.24 to 2.31), as were phosphate level greater than 5.5 mg/dL (HR, 1.59; 95% CI, 1.16 to 2.17) and potassium level greater than 5.0 mEq/L (HR, 1.50; 95% CI, 1.10 to 2.06). Skipping was associated with a lower likelihood of kidney transplantation in those younger than 65 years (OR, 0.41; 95% CI, 0.18 to 0.93). CONCLUSION: These findings show that hemodialysis patients of black race and those with current tobacco or illicit drug use are at risk for skipping dialysis treatments. Skipping treatments and markers of poor dietary adherence are strongly associated with greater risk for death. Targeting high-risk patients to understand reasons for nonadherence and to intervene could prevent premature death. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/16310577/Skipped_treatments_markers_of_nutritional_nonadherence_and_survival_among_incident_hemodialysis_patients_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(05)01338-7 DB - PRIME DP - Unbound Medicine ER -