Tags

Type your tag names separated by a space and hit enter

Survival and transplantation in end-stage renal disease: a prospective study of a multiethnic population.
Nephrol Dial Transplant. 2009 Dec; 24(12):3840-6.ND

Abstract

INTRODUCTION

Accurate assessment of determinants of patient survival in end-stage renal disease is important for counselling, clinical management and resource planning. To address this we have analysed survival and risk factors for survival for patients treated for end-stage renal disease in a multi-ethnic UK population.

METHODS

A multicentre prospective observational cohort study was performed in four teaching hospital renal units serving a total population of four million people. A total of 884 consecutive patients treated with renal replacement therapy were studied. Cox proportional hazard modelling and adjusted survival curves were used to assess the impact of a range of variables on patients surviving dialysis for more than 90 days. Further analysis was undertaken to determine the likelihood of transplantation in different ethnic groups.

RESULTS

Survival was 29% after a mean and median follow up of 4.6 and 4.2 years, respectively. Factors associated with worse survival included the following: age; for each decade of life the relative risk (RR) of death was 1.52 (95% confidence intervals 1.41-1.65, p < 0.0001); comorbidity, one or two comorbid conditions, RR = 1.56 (95% CI 1.24-1.95, p < 0.001) and three or more comorbid conditions, RR = 2.34 (1.68-3.27, p < 0.001). Factors associated with better survival included the following: south-Asian ethnicity, RR = 0.6 (0.46-0.80, p < 0.001); renal transplantation, RR = 0.20 (95% CI 0.11-0.59, p < 0.0001) and glomerulonephritis as the primary renal disease, RR = 0.70 (0.50-0.97, p = 0.04). Factors associated with likelihood of transplantion were having a functioning fistula/peritoneal dialysis catheter at start of dialysis (RR 1.91, 95% CI 1.24-2.94, p = 0.003) and glomerulonephritis (RR 9.54, 95% CI 2.43-37.64, p = 0.001). Patients were less likely to receive if they were black (RR 0.10, 95% CI 0.02-0.34, p < 0.001), South Asian (RR 0.64, 95% CI 0.42-0.97, p = 0.037), diabetic (RR 0.06, 95% CI 0.01-0.23, p < 0.001) and had one or two comorbid conditions (RR 0.51, 95% CI 0.32-0.82, p = 0.06). Every decade increase in age was also associated with a lesser likelihood of transplantation (RR 0.55, 95% CI 0.49-0.61, p < 0.001). Discussion. Risk stratification at commencement of chronic dialysis may predict long-term survival in different patient groups. As expected ethnic minorities are less likely to receive a transplant and this should be addressed by the new waiting list prioritization. The better survival on dialysis in this population of patients with south-Asian ethnicity is unexplained and this requires further investigation.

Authors+Show Affiliations

Department of Nephrology, University Hospital Birmingham, West Midlands, UK. poorva.jain@doctors.org.ukNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

Journal Article
Multicenter Study

Language

eng

PubMed ID

19755474

Citation

Jain, Poorva, et al. "Survival and Transplantation in End-stage Renal Disease: a Prospective Study of a Multiethnic Population." Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, vol. 24, no. 12, 2009, pp. 3840-6.
Jain P, Cockwell P, Little J, et al. Survival and transplantation in end-stage renal disease: a prospective study of a multiethnic population. Nephrol Dial Transplant. 2009;24(12):3840-6.
Jain, P., Cockwell, P., Little, J., Ferring, M., Nicholas, J., Richards, N., Higgins, R., & Smith, S. (2009). Survival and transplantation in end-stage renal disease: a prospective study of a multiethnic population. Nephrology, Dialysis, Transplantation : Official Publication of the European Dialysis and Transplant Association - European Renal Association, 24(12), 3840-6. https://doi.org/10.1093/ndt/gfp455
Jain P, et al. Survival and Transplantation in End-stage Renal Disease: a Prospective Study of a Multiethnic Population. Nephrol Dial Transplant. 2009;24(12):3840-6. PubMed PMID: 19755474.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Survival and transplantation in end-stage renal disease: a prospective study of a multiethnic population. AU - Jain,Poorva, AU - Cockwell,Paul, AU - Little,Jane, AU - Ferring,Martin, AU - Nicholas,Johann, AU - Richards,Nick, AU - Higgins,Rob, AU - Smith,Steve, Y1 - 2009/09/15/ PY - 2009/9/17/entrez PY - 2009/9/17/pubmed PY - 2010/2/3/medline SP - 3840 EP - 6 JF - Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association JO - Nephrol Dial Transplant VL - 24 IS - 12 N2 - INTRODUCTION: Accurate assessment of determinants of patient survival in end-stage renal disease is important for counselling, clinical management and resource planning. To address this we have analysed survival and risk factors for survival for patients treated for end-stage renal disease in a multi-ethnic UK population. METHODS: A multicentre prospective observational cohort study was performed in four teaching hospital renal units serving a total population of four million people. A total of 884 consecutive patients treated with renal replacement therapy were studied. Cox proportional hazard modelling and adjusted survival curves were used to assess the impact of a range of variables on patients surviving dialysis for more than 90 days. Further analysis was undertaken to determine the likelihood of transplantation in different ethnic groups. RESULTS: Survival was 29% after a mean and median follow up of 4.6 and 4.2 years, respectively. Factors associated with worse survival included the following: age; for each decade of life the relative risk (RR) of death was 1.52 (95% confidence intervals 1.41-1.65, p < 0.0001); comorbidity, one or two comorbid conditions, RR = 1.56 (95% CI 1.24-1.95, p < 0.001) and three or more comorbid conditions, RR = 2.34 (1.68-3.27, p < 0.001). Factors associated with better survival included the following: south-Asian ethnicity, RR = 0.6 (0.46-0.80, p < 0.001); renal transplantation, RR = 0.20 (95% CI 0.11-0.59, p < 0.0001) and glomerulonephritis as the primary renal disease, RR = 0.70 (0.50-0.97, p = 0.04). Factors associated with likelihood of transplantion were having a functioning fistula/peritoneal dialysis catheter at start of dialysis (RR 1.91, 95% CI 1.24-2.94, p = 0.003) and glomerulonephritis (RR 9.54, 95% CI 2.43-37.64, p = 0.001). Patients were less likely to receive if they were black (RR 0.10, 95% CI 0.02-0.34, p < 0.001), South Asian (RR 0.64, 95% CI 0.42-0.97, p = 0.037), diabetic (RR 0.06, 95% CI 0.01-0.23, p < 0.001) and had one or two comorbid conditions (RR 0.51, 95% CI 0.32-0.82, p = 0.06). Every decade increase in age was also associated with a lesser likelihood of transplantation (RR 0.55, 95% CI 0.49-0.61, p < 0.001). Discussion. Risk stratification at commencement of chronic dialysis may predict long-term survival in different patient groups. As expected ethnic minorities are less likely to receive a transplant and this should be addressed by the new waiting list prioritization. The better survival on dialysis in this population of patients with south-Asian ethnicity is unexplained and this requires further investigation. SN - 1460-2385 UR - https://www.unboundmedicine.com/medline/citation/19755474/Survival_and_transplantation_in_end_stage_renal_disease:_a_prospective_study_of_a_multiethnic_population_ L2 - https://academic.oup.com/ndt/article-lookup/doi/10.1093/ndt/gfp455 DB - PRIME DP - Unbound Medicine ER -