Kidney Res Clin Pract.  2021 Sep;40(3):419-431. 10.23876/j.krcp.20.231.

Preexisting comorbidities are associated with the mortality rate as well as the predialysis adverse events in incident dialysis patients

• Lee MJ
• Park I
• Kim H
• Shin GT
• Jeong JC

• KMID: 2524388
• DOI: http://doi.org/10.23876/j.krcp.20.231

Abstract

Background
Optimal estimated glomerular filtration rate (eGFR) to start maintenance dialysis is controversial. Observational studies have reported that initiation of dialysis at high eGFRs is associated with worse postdialysis survival.
Methods
We retrospectively investigated 1,038 incident dialysis patients who started maintenance dialysis during 2010-2015. Patients were assessed for comorbidities and adverse events during the transitional period of dialysis initiation. Patients were classified as planned dialysis (PD) vs. unplanned dialysis (UD) according to indications for dialysis initiation.
Results
UD group comprised 352 patients (33.9%). Mean eGFR at dialysis initiation was higher in UD patients than PD patients (7.9 ± 5.1 mL/min/1.73 m2 vs. 5.9 ± 3.4 mL/min/1.73 m2, p < 0.001). Mean Davies comorbidity index in the UD group was higher than in the PD group (1.3 ± 1.0 vs. 0.9 ± 1.0, p < 0.001). In multivariable Cox regression, patients with more comorbidities experienced more ischemic heart disease (hazard ratio [HR], 4.36; 95% confidence interval [CI], 1.71–11.14) in the medium-risk group and HR of 8.84 (95% CI, 3.06–25.55) in the high-risk group (vs. low-risk group, p < 0.001)) during the predialysis period. High-risk group had increased postdialysis mortality (HR, 2.48; 95% CI, 1.46–4.20; p = 0.001). Adjusted HR of mortality was higher in the medium-risk group of UD patients (HR, 1.72; 95% CI, 1.16–2.56; p = 0.007).
Conclusion
Patients with more comorbidities were at increased risk of predialysis ischemic heart disease and postdialysis mortality. UD patients in the medium-risk population had increased risk of postdialysis mortality. Dialysis start should be individualized by considering comorbidities.

Keyword

Comorbidity index; Dialysis initiation; Estimated glomerular filtration rate; Predialysis adverse outcomes