Abstract
BackgroundPatients with late referral and positive history of volume overload may have a poor prognosis after initiating dialysis due to insufficient and/or inadequate management of complications of renal failure and the lack of better dialysis preparation. Little is known about the influence of the relationship between history of volume overload and late referral on prognosis.MethodsWe analyzed 1475 patients who had initiated dialysis for the first time from October 2011 to September 2013. late referral was defined as referral to a nephrologist < 3 months before dialysis initiation. The major outcomes were all-cause death and deaths due to cardiovascular diseases (CVD). The impact of late referral and history of volume overload on all-cause mortality was assessed by Cox proportional hazards models.ResultsAmong 1475 patients, the mean patient age was 67.5 years. During the median follow-up of 2.2 years, 260 deaths occurred; 99 were due to CVD. Cox proportional hazards models demonstrated that late referral (adjusted hazard ratio [HR], 1.35; 95% confidence interval [CI], 1.00–1.82) and history of volume overload (adjusted HR, 1.39; 95% CI, 1.06–1.81) were risk factors for all-cause mortality. Furthermore, late referral coexisting was associated with a history of volume overload increased mortality (adjusted HR, 2.10; 95% CI, 1.39–3.16 versus absence of late referral without history of volume overload) after adjusting for age, sex, diabetes, atherosclerotic disease, and laboratory values.ConclusionsBoth late referral and history of volume overload were associated with increased risks of all-cause mortality.Trial registrationUniversity Hospital Medical Information Network (UMIN000007096). Registered 18 January 2012, retrospectively registered.https://upload.umin.ac.jp/cgi-open-bin/ctr_e/ctr_view.cgi?recptno=R000008349.
Highlights
Patients with late referral and positive history of volume overload may have a poor prognosis after initiating dialysis due to insufficient and/or inadequate management of complications of renal failure and the lack of better dialysis preparation
The major benefits of nephrology care in Chronic kidney disease (CKD) patients include a) identification of reversible causes of renal failure and slowing the rate of progression to End-stage renal disease (ESRD); b) management of complications of renal failure, including volume overload which can lead to left ventricular hypertrophy, mineral and bone disorders associated with cardiovascular disease (CVD), hypertension, and anemia; and c) better preparation for renal replacement therapy (RRT) and placement of dialysis access [1,2,3]
We evaluated the effects and the relationships between late referral and clinical history of volume overload on all-cause mortality and cardiovascular diseases (CVD)-related mortality among patients newly initiated to dialysis registered with the multicenter prospective study, the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP)
Summary
Patients with late referral and positive history of volume overload may have a poor prognosis after initiating dialysis due to insufficient and/or inadequate management of complications of renal failure and the lack of better dialysis preparation. In patients with CKD progressing to end-stage renal disease (ESRD), timely referral to a nephrologist and adequate nephrologist care are important for managing several risk factors associated with adverse outcomes. The major benefits of nephrology care in CKD patients include a) identification of reversible causes of renal failure and slowing the rate of progression to ESRD; b) management of complications of renal failure, including volume overload which can lead to left ventricular hypertrophy, mineral and bone disorders associated with cardiovascular disease (CVD), hypertension, and anemia; and c) better preparation for renal replacement therapy (RRT) and placement of dialysis access [1,2,3]. Considering the leading cause of death for patients with ESRD is CVD [10], further studies are needed to investigate the risk factors associated with mortality after dialysis in patients with late referral
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