Duration of predialysis nephrological care and mortality after dialysis initiation.

Abstract

The duration of predialysis nephrological care that can reduceall-cause and cardiovascularmortality after dialysis initiation has not been clarified. A total of 1117 patients who started chronic dialysis treatment from 2006 to 2015 at Osaka General Medical Center were analyzed.Independent risk factors associated with all-cause and cardiovascular mortalityafter dialysis initiationand early death (death within 12months after dialysis initiation) were identified using Cox proportional hazards analysis. Moreover, the duration of predialysis nephrology care that could reduce mortality was explored using severaldifferentdefinitions ofearly referral as well as "6months" commonly used in previous studies. Of 1117 patients, 834 were referred6months before dialysis initiation.During the follow-up period (median, 34months), 324 patients diedafter dialysis initiation. Although multivariate Cox analysis did not show a favorable association betweenearly referral of"6months before dialysis initiation" and all-cause and cardiovascular mortality, 20-month predialysis nephrological care was associated with better first-yearoverallsurvival after dialysis initiation (hazard ratio 0.58; 95% confidence interval 0.35-0.98; P = 0.040). More than 6months nephrological care before dialysis initiation was not early enough to reduceall-cause and cardiovascular mortality after dialysis initiation. Our results suggest that nephrology referral 20months before dialysis initiation would be necessary toreducefirst-yearoverall survivalafter dialysis initiation.