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Survival among older adults with kidney failure is better in the first three years with chronic dialysis treatment than not

Tam-Tham, Helen; Quinn, Robert R.; Weaver, Robert G.; Zhang, Jianguo; Ravani, Pietro; Liu, Ping; Thomas, Chandra; King-Shier, Kathryn; Fruetel, Karen; James, Matt T.; Manns, Braden J.; Tonelli, Marcello; Murtagh, Fliss E.M.; Hemmelgarn, Brenda R.

Authors

Helen Tam-Tham

Robert R. Quinn

Robert G. Weaver

Jianguo Zhang

Pietro Ravani

Ping Liu

Chandra Thomas

Kathryn King-Shier

Karen Fruetel

Matt T. James

Braden J. Manns

Marcello Tonelli

Brenda R. Hemmelgarn



Abstract

Comparisons of survival between dialysis and nondialysis care for older adults with kidney failure have been limited to those managed by nephrologists, and are vulnerable to lead and immortal time biases. So we compared time to all-cause mortality among older adults with kidney failure treated vs. not treated with chronic dialysis. Our retrospective cohort study used linked administrative and laboratory data to identify adults aged 65 or more years of age in Alberta, Canada, with kidney failure (2002-2012), defined by two or more consecutive outpatient estimated glomerular filtration rates less than 10 mL/min/1.73m2, spanning 90 or more days. We used marginal structural Cox models to assess the association between receipt of dialysis and all-cause mortality by allowing control for both time-varying and baseline confounders. Overall, 838 patients met inclusion criteria (mean age 79.1; 48.6% male; mean estimated glomerular filtration rate 7.8 mL/min/1.73m2). Dialysis treatment (vs. no dialysis) was associated with a significantly lower risk of death for the first three years of follow-up (hazard ratio 0.59 [95% confidence interval 0.46-0.77]), but not thereafter (1.22 [0.69-2.17]). However, dialysis was associated with a significantly higher risk of hospitalization (1.40 [1.16-1.69]). Thus, among older adults with kidney failure, treatment with dialysis was associated with longer survival up to three years after reaching kidney failure, though with a higher risk of hospital admissions. These findings may assist shared decision-making about treatment of kidney failure.

Citation

Tam-Tham, H., Quinn, R. R., Weaver, R. G., Zhang, J., Ravani, P., Liu, P., Thomas, C., King-Shier, K., Fruetel, K., James, M. T., Manns, B. J., Tonelli, M., Murtagh, F. E., & Hemmelgarn, B. R. (2018). Survival among older adults with kidney failure is better in the first three years with chronic dialysis treatment than not. Kidney International, 94(3), 582-588. https://doi.org/10.1016/j.kint.2018.03.007

Journal Article Type Article
Acceptance Date Mar 2, 2018
Online Publication Date May 24, 2018
Publication Date Sep 1, 2018
Deposit Date Apr 29, 2018
Publicly Available Date May 25, 2019
Journal Kidney International
Print ISSN 0085-2538
Publisher Elsevier
Peer Reviewed Peer Reviewed
Volume 94
Issue 3
Pages 582-588
DOI https://doi.org/10.1016/j.kint.2018.03.007
Keywords Chronic dialysis; Chronic kidney disease; Geriatric nephrology; Kidney failure; Nondialysis care; Survival
Public URL https://hull-repository.worktribe.com/output/808110
Publisher URL https://www.sciencedirect.com/science/article/abs/pii/S0085253818302461?via%3Dihub
Contract Date Apr 30, 2018

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