Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan
Abstract Background 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. Little is known about the influe...
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| Format: | Article |
| Language: | English |
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BMC
2018-03-01
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| Series: | BMC Nephrology |
| Subjects: | |
| Online Access: | http://link.springer.com/article/10.1186/s12882-018-0859-8 |
| _version_ | 1818262525513302016 |
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| author | Masaki Okazaki Daijo Inaguma Takahiro Imaizumi Akiko Kada Takaaki Yaomura Naotake Tsuboi Shoichi Maruyama |
| author_facet | Masaki Okazaki Daijo Inaguma Takahiro Imaizumi Akiko Kada Takaaki Yaomura Naotake Tsuboi Shoichi Maruyama |
| author_sort | Masaki Okazaki |
| collection | DOAJ |
| description | Abstract Background 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. Little is known about the influence of the relationship between history of volume overload and late referral on prognosis. Methods We 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. Results Among 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. Conclusions Both late referral and history of volume overload were associated with increased risks of all-cause mortality. Trial registration University 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. |
| first_indexed | 2024-12-12T19:04:31Z |
| format | Article |
| id | doaj.art-f54da319a38549c2a7713546f1d0f6cb |
| institution | Directory Open Access Journal |
| issn | 1471-2369 |
| language | English |
| last_indexed | 2024-12-12T19:04:31Z |
| publishDate | 2018-03-01 |
| publisher | BMC |
| record_format | Article |
| series | BMC Nephrology |
| spelling | doaj.art-f54da319a38549c2a7713546f1d0f6cb2022-12-22T00:15:00ZengBMCBMC Nephrology1471-23692018-03-0119111010.1186/s12882-018-0859-8Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in JapanMasaki Okazaki0Daijo Inaguma1Takahiro Imaizumi2Akiko Kada3Takaaki Yaomura4Naotake Tsuboi5Shoichi Maruyama6Department of Nephrology, Nagoya University Graduate School of MedicineDepartment of Nephrology, Fujita Health University School of MedicineDepartment of Nephrology, Nagoya University Graduate School of MedicineDepartment of Clinical Trials and Research, Clinical Research Center, National Hospital Organization Nagoya Medical CenterDepartment of Nephrology, National Hospital Organization Nagoya Medical CenterDepartment of Nephrology, Nagoya University Graduate School of MedicineDepartment of Nephrology, Nagoya University Graduate School of MedicineAbstract Background 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. Little is known about the influence of the relationship between history of volume overload and late referral on prognosis. Methods We 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. Results Among 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. Conclusions Both late referral and history of volume overload were associated with increased risks of all-cause mortality. Trial registration University 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.http://link.springer.com/article/10.1186/s12882-018-0859-8Predialysis nephrologist careEarly versus late referralHemodialysis initiation |
| spellingShingle | Masaki Okazaki Daijo Inaguma Takahiro Imaizumi Akiko Kada Takaaki Yaomura Naotake Tsuboi Shoichi Maruyama Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan BMC Nephrology Predialysis nephrologist care Early versus late referral Hemodialysis initiation |
| title | Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan |
| title_full | Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan |
| title_fullStr | Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan |
| title_full_unstemmed | Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan |
| title_short | Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis: a multicenter prospective cohort study in Japan |
| title_sort | unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis a multicenter prospective cohort study in japan |
| topic | Predialysis nephrologist care Early versus late referral Hemodialysis initiation |
| url | http://link.springer.com/article/10.1186/s12882-018-0859-8 |
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