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Signs and symptoms associated with earlier dialysis initiation in nursing home residents.
Am J Kidney Dis 2010; 56(6):1117-26AJ

Abstract

BACKGROUND

Factors driving the trend of earlier dialysis initiation for persons with end-stage renal disease are unknown. We wanted to determine the association of the number and type of signs and symptoms with timing of initiation of dialysis in US nursing home residents.

STUDY DESIGN

Observational study.

SETTING & PARTICIPANTS

We used data from the US Renal Data System linked with the Minimum Data Set, a national registry of nursing home residents. The cohort consisted of 2,402 nursing home residents who initiated dialysis between 1998 and 2000 and had at least 2 recorded clinical assessments in the year before dialysis initiation.

PREDICTORS

We evaluated 7 clinical signs and symptoms: dependence in activities of daily living, cognitive function, edema, dyspnea, nutritional problems, vomiting, and body size.

OUTCOMES

Earlier dialysis initiation was defined as estimated glomerular filtration rate ≥ 1 5 mL/min/1.73 m² at the start of dialysis.

RESULTS

Median estimated glomerular filtration rate at the start of dialysis was 9.8 (25th-75th percentile, 7.4-13.4) mL/min/1.73 m². After adjustment for age, sex, race, and comorbid conditions, each additional sign or symptom was associated with a higher odds for earlier dialysis initiation (OR, 1.16 per symptom; 95% CI, 1.06-1.28), as was each adversely changing sign or symptom (OR, 1.26 per symptom; 95% CI, 1.16-1.38). The population-attributable risk for earlier dialysis initiation associated with having one or more signs and symptoms of volume overload, cognitive decline, increasing activities of daily living dependence, and weight loss was 31%; volume overload had the largest aggregate population-attributable risk.

LIMITATIONS

We lacked information about metabolic indications for dialysis initiation.

CONCLUSIONS

Volume overload, cognitive decline, increasing activities of daily living dependence, and weight loss were associated with earlier dialysis initiation; however, these factors explained less than one-third of cases of earlier dialysis initiation in nursing home residents.

Authors+Show Affiliations

Division of Nephrology, Department of Medicine, Stanford University School of Medicine, Palo Alto, CA, USA. mktamura@stanford.eduNo affiliation info availableNo affiliation info availableNo affiliation info available

Pub Type(s)

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

Language

eng

PubMed ID

20974509

Citation

Kurella Tamura, Manjula, et al. "Signs and Symptoms Associated With Earlier Dialysis Initiation in Nursing Home Residents." American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, vol. 56, no. 6, 2010, pp. 1117-26.
Kurella Tamura M, O'Hare AM, McCulloch CE, et al. Signs and symptoms associated with earlier dialysis initiation in nursing home residents. Am J Kidney Dis. 2010;56(6):1117-26.
Kurella Tamura, M., O'Hare, A. M., McCulloch, C. E., & Johansen, K. L. (2010). Signs and symptoms associated with earlier dialysis initiation in nursing home residents. American Journal of Kidney Diseases : the Official Journal of the National Kidney Foundation, 56(6), pp. 1117-26. doi:10.1053/j.ajkd.2010.08.017.
Kurella Tamura M, et al. Signs and Symptoms Associated With Earlier Dialysis Initiation in Nursing Home Residents. Am J Kidney Dis. 2010;56(6):1117-26. PubMed PMID: 20974509.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Signs and symptoms associated with earlier dialysis initiation in nursing home residents. AU - Kurella Tamura,Manjula, AU - O'Hare,Ann M, AU - McCulloch,Charles E, AU - Johansen,Kirsten L, Y1 - 2010/10/25/ PY - 2010/04/23/received PY - 2010/08/09/accepted PY - 2010/10/27/entrez PY - 2010/10/27/pubmed PY - 2010/12/17/medline SP - 1117 EP - 26 JF - American journal of kidney diseases : the official journal of the National Kidney Foundation JO - Am. J. Kidney Dis. VL - 56 IS - 6 N2 - BACKGROUND: Factors driving the trend of earlier dialysis initiation for persons with end-stage renal disease are unknown. We wanted to determine the association of the number and type of signs and symptoms with timing of initiation of dialysis in US nursing home residents. STUDY DESIGN: Observational study. SETTING & PARTICIPANTS: We used data from the US Renal Data System linked with the Minimum Data Set, a national registry of nursing home residents. The cohort consisted of 2,402 nursing home residents who initiated dialysis between 1998 and 2000 and had at least 2 recorded clinical assessments in the year before dialysis initiation. PREDICTORS: We evaluated 7 clinical signs and symptoms: dependence in activities of daily living, cognitive function, edema, dyspnea, nutritional problems, vomiting, and body size. OUTCOMES: Earlier dialysis initiation was defined as estimated glomerular filtration rate ≥ 1 5 mL/min/1.73 m² at the start of dialysis. RESULTS: Median estimated glomerular filtration rate at the start of dialysis was 9.8 (25th-75th percentile, 7.4-13.4) mL/min/1.73 m². After adjustment for age, sex, race, and comorbid conditions, each additional sign or symptom was associated with a higher odds for earlier dialysis initiation (OR, 1.16 per symptom; 95% CI, 1.06-1.28), as was each adversely changing sign or symptom (OR, 1.26 per symptom; 95% CI, 1.16-1.38). The population-attributable risk for earlier dialysis initiation associated with having one or more signs and symptoms of volume overload, cognitive decline, increasing activities of daily living dependence, and weight loss was 31%; volume overload had the largest aggregate population-attributable risk. LIMITATIONS: We lacked information about metabolic indications for dialysis initiation. CONCLUSIONS: Volume overload, cognitive decline, increasing activities of daily living dependence, and weight loss were associated with earlier dialysis initiation; however, these factors explained less than one-third of cases of earlier dialysis initiation in nursing home residents. SN - 1523-6838 UR - https://www.unboundmedicine.com/medline/citation/20974509/Signs_and_symptoms_associated_with_earlier_dialysis_initiation_in_nursing_home_residents_ L2 - https://linkinghub.elsevier.com/retrieve/pii/S0272-6386(10)01273-4 DB - PRIME DP - Unbound Medicine ER -