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Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access.
Am J Kidney Dis. 2009 Jan; 53(1):79-90.AJ

Abstract

BACKGROUND

To determine the most significant potentially actionable clinical variables associated with mortality and hospitalization risk in hemodialysis (HD) patients.

STUDY DESIGN

Cohort study.

SETTING & PARTICIPANTS

Adult maintenance HD patients in the Fresenius Medical Care, North America database as of January 1, 2004, with baseline information from October 1, 2003, to December 31, 2003, comprising approximately 26% of the US HD population.

PREDICTORS

Case-mix (age, sex, race, diabetes, vintage, and body surface area), vascular access, and laboratory (albumin, equilibrated Kt/V, hemoglobin, calcium, phosphorus, creatinine, bicarbonate, biointact parathyroid hormone, transferrin saturation, and white blood cell count) variables.

OUTCOMES

1-year mortality and hospitalization risk from January 1 to December 31, 2004.

MEASUREMENTS

Cox proportional hazards models for death and hospitalization.

RESULTS

The cohort (N = 78,420) had a mean age of 61.4 +/- 15.0 years, 47% were women, 49% were white, 41% were black race (10% defined as "other"), and 52% had diabetes. The top 5 actionable variables were the same for mortality and hospitalization. Final case-mix plus laboratory-adjusted hazard ratios for these top 5 actionable variables indicate 177% increased risk of death and 67% increased risk of hospitalization per 1-g/dL decrease in albumin level, 39% and 45% greater risk with catheters compared with fistulas, 18% and 9% greater risk per 1-mg/dL greater phosphorus level, 11% and 9% lower risk per 1-g/dL greater hemoglobin level, and 5% and 2% greater risk per 0.1-unit decrease in equilibrated Kt/V, respectively (all P < 0.0001).

LIMITATIONS

Observational cross-sectional study with limited comorbidity adjustment (for diabetes).

CONCLUSION

The same variables are associated with both mortality and hospitalization in HD patients. The top 5 potentially actionable variables are readily identifiable, with albumin level and catheter use the most prominent, and all 5 are appropriate targets for improvement.

Authors+Show Affiliations

Fresenius Medical Care North America, 920 Winter St., Waltham, MA 02451-1457, USA. elacsonj@fmc-na.comNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article

Language

eng

PubMed ID

18930570

Citation

Lacson, Eduardo, et al. "Associates of Mortality and Hospitalization in Hemodialysis: Potentially Actionable Laboratory Variables and Vascular Access." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 53, no. 1, 2009, pp. 79-90.
Lacson E, Wang W, Hakim RM, et al. Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access. Am J Kidney Dis. 2009;53(1):79-90.
Lacson, E., Wang, W., Hakim, R. M., Teng, M., & Lazarus, J. M. (2009). Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 53(1), 79-90. https://doi.org/10.1053/j.ajkd.2008.07.031
Lacson E, et al. Associates of Mortality and Hospitalization in Hemodialysis: Potentially Actionable Laboratory Variables and Vascular Access. Am J Kidney Dis. 2009;53(1):79-90. PubMed PMID: 18930570.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Associates of mortality and hospitalization in hemodialysis: potentially actionable laboratory variables and vascular access. AU - Lacson,Eduardo,Jr AU - Wang,Weiling, AU - Hakim,Raymond M, AU - Teng,Ming, AU - Lazarus,J Michael, Y1 - 2008/10/18/ PY - 2007/11/20/received PY - 2008/07/29/accepted PY - 2008/10/22/pubmed PY - 2009/1/9/medline PY - 2008/10/22/entrez SP - 79 EP - 90 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am J Kidney Dis VL - 53 IS - 1 N2 - BACKGROUND: To determine the most significant potentially actionable clinical variables associated with mortality and hospitalization risk in hemodialysis (HD) patients. STUDY DESIGN: Cohort study. SETTING & PARTICIPANTS: Adult maintenance HD patients in the Fresenius Medical Care, North America database as of January 1, 2004, with baseline information from October 1, 2003, to December 31, 2003, comprising approximately 26% of the US HD population. PREDICTORS: Case-mix (age, sex, race, diabetes, vintage, and body surface area), vascular access, and laboratory (albumin, equilibrated Kt/V, hemoglobin, calcium, phosphorus, creatinine, bicarbonate, biointact parathyroid hormone, transferrin saturation, and white blood cell count) variables. OUTCOMES: 1-year mortality and hospitalization risk from January 1 to December 31, 2004. MEASUREMENTS: Cox proportional hazards models for death and hospitalization. RESULTS: The cohort (N = 78,420) had a mean age of 61.4 +/- 15.0 years, 47% were women, 49% were white, 41% were black race (10% defined as "other"), and 52% had diabetes. The top 5 actionable variables were the same for mortality and hospitalization. Final case-mix plus laboratory-adjusted hazard ratios for these top 5 actionable variables indicate 177% increased risk of death and 67% increased risk of hospitalization per 1-g/dL decrease in albumin level, 39% and 45% greater risk with catheters compared with fistulas, 18% and 9% greater risk per 1-mg/dL greater phosphorus level, 11% and 9% lower risk per 1-g/dL greater hemoglobin level, and 5% and 2% greater risk per 0.1-unit decrease in equilibrated Kt/V, respectively (all P < 0.0001). LIMITATIONS: Observational cross-sectional study with limited comorbidity adjustment (for diabetes). CONCLUSION: The same variables are associated with both mortality and hospitalization in HD patients. The top 5 potentially actionable variables are readily identifiable, with albumin level and catheter use the most prominent, and all 5 are appropriate targets for improvement. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/18930570/Associates_of_mortality_and_hospitalization_in_hemodialysis:_potentially_actionable_laboratory_variables_and_vascular_access_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(08)01234-1 DB - PRIME DP - Unbound Medicine ER -