Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study
Long-term and continuous nephrology care effects on post-dialysis mortality remain unclear. This study aims to systematically explore the causal effect of nephrology care on mortality for patients with dialysis initiation. We conducted a retrospective cohort study to include incident patients with d...
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| Format: | Article |
| Language: | English |
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MDPI AG
2021-10-01
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| Series: | Journal of Personalized Medicine |
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| Online Access: | https://www.mdpi.com/2075-4426/11/11/1071 |
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| author | Cheng-Yin Chung Ping-Hsun Wu Yi-Wen Chiu Shang-Jyh Hwang Ming-Yen Lin |
| author_facet | Cheng-Yin Chung Ping-Hsun Wu Yi-Wen Chiu Shang-Jyh Hwang Ming-Yen Lin |
| author_sort | Cheng-Yin Chung |
| collection | DOAJ |
| description | Long-term and continuous nephrology care effects on post-dialysis mortality remain unclear. This study aims to systematically explore the causal effect of nephrology care on mortality for patients with dialysis initiation. We conducted a retrospective cohort study to include incident patients with dialysis for ≥ 3 months in Taiwan from 2004 through 2011. The continuous nephrology care of incident patients in the three years before their dialysis was measured every six months. Continuous nephrology care was determined by 0–6, 0–12, …, 0–36 months and their counterparts; and none, intermittent, 0–6 months, …, and 0–36 months. Simple and weighted hazards ratio (HR) and 95% confidence interval (CI) for one-year mortality were estimated after propensity score (PS) matching. We included a total of 44,698 patients (mean age 63.3 ± 14.2, male 51.9%). Receiving ≥ 1 year predialysis nephrology care was associated with a 22% lower post-dialysis mortality hazard. No different effects were found (ranges of PS matching HR: 0.77–0.80) when comparing the defined duration of nephrology care with their counterparts. Stepped survival benefits were newly identified in the intermittent care, which had slightly lower HRs (weighted HR: 0.88, 95% CI: 0.79–0.97), followed by reviving care over six months to two years (ranges of weighted HR: 0.60–0.65), and reviving care over two years (ranges of weighted HR: 0.48–0.52). There was no existing critical period of nephrology care effect on post-dialysis, but there were extra survival benefits when extending nephrology care to >2 years, which suggests that continuous and long-term care during pre-dialysis/chronic kidney disease phase is required. |
| first_indexed | 2024-03-10T05:22:27Z |
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| issn | 2075-4426 |
| language | English |
| last_indexed | 2024-03-10T05:22:27Z |
| publishDate | 2021-10-01 |
| publisher | MDPI AG |
| record_format | Article |
| series | Journal of Personalized Medicine |
| spelling | doaj.art-35a076e44818440091b98981cdd2b0202023-11-22T23:57:30ZengMDPI AGJournal of Personalized Medicine2075-44262021-10-011111107110.3390/jpm11111071Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort StudyCheng-Yin Chung0Ping-Hsun Wu1Yi-Wen Chiu2Shang-Jyh Hwang3Ming-Yen Lin4Division of Nephrology, Department of Internal Medicine, Ministry of Health and Welfare, Pingtung Hospital, Pingtung 90054, TaiwanDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, TaiwanDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, TaiwanDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, TaiwanDivision of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital, Kaohsiung Medical University, Kaohsiung 80756, TaiwanLong-term and continuous nephrology care effects on post-dialysis mortality remain unclear. This study aims to systematically explore the causal effect of nephrology care on mortality for patients with dialysis initiation. We conducted a retrospective cohort study to include incident patients with dialysis for ≥ 3 months in Taiwan from 2004 through 2011. The continuous nephrology care of incident patients in the three years before their dialysis was measured every six months. Continuous nephrology care was determined by 0–6, 0–12, …, 0–36 months and their counterparts; and none, intermittent, 0–6 months, …, and 0–36 months. Simple and weighted hazards ratio (HR) and 95% confidence interval (CI) for one-year mortality were estimated after propensity score (PS) matching. We included a total of 44,698 patients (mean age 63.3 ± 14.2, male 51.9%). Receiving ≥ 1 year predialysis nephrology care was associated with a 22% lower post-dialysis mortality hazard. No different effects were found (ranges of PS matching HR: 0.77–0.80) when comparing the defined duration of nephrology care with their counterparts. Stepped survival benefits were newly identified in the intermittent care, which had slightly lower HRs (weighted HR: 0.88, 95% CI: 0.79–0.97), followed by reviving care over six months to two years (ranges of weighted HR: 0.60–0.65), and reviving care over two years (ranges of weighted HR: 0.48–0.52). There was no existing critical period of nephrology care effect on post-dialysis, but there were extra survival benefits when extending nephrology care to >2 years, which suggests that continuous and long-term care during pre-dialysis/chronic kidney disease phase is required.https://www.mdpi.com/2075-4426/11/11/1071dialysisend-stage kidney diseasemortalitynephrology carecausal inference |
| spellingShingle | Cheng-Yin Chung Ping-Hsun Wu Yi-Wen Chiu Shang-Jyh Hwang Ming-Yen Lin Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study Journal of Personalized Medicine dialysis end-stage kidney disease mortality nephrology care causal inference |
| title | Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study |
| title_full | Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study |
| title_fullStr | Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study |
| title_full_unstemmed | Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study |
| title_short | Effect of Nephrology Care on Mortality in Incident Dialysis Patients: A Population-Based Cohort Study |
| title_sort | effect of nephrology care on mortality in incident dialysis patients a population based cohort study |
| topic | dialysis end-stage kidney disease mortality nephrology care causal inference |
| url | https://www.mdpi.com/2075-4426/11/11/1071 |
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