End-stage renal disease versus death in a Portuguese cohort of elderly patients: an approach using competing event analysis

• Type: Article in International Scientific Journal
• Date: 2017

Authors

Santos, J (Author) Other; Fonseca, I (Author) Other; Malheiro, J (Author) Other; beirao, i (Author) ICBAS; Lobato, L (Author) Other; oliveira, p (Author) ICBAS; Cabrita, A (Author) Other

Journal

Title: Journal of Investigative Medicine

Vol. 65

Pages: 1041-1048

ISSN: 1081-5589

Publisher: BMJ PUBLISHING GROUP

Indexing

ISI Web of Knowledge - 2 Citations

Scopus - 2 Citations

Other information

Authenticus ID: P-00N-3DX

DOI: 10.1136/jim-2017-000480

Abstract (EN): Chronic kidney disease (CKD) is higher in elderly, but mortality outweighs the risk of end-stage renal disease (ESRD). Our aim was to identify prognostic markers for ESRD or death in elderly CKD, within a competing-risk analysis. This is a longitudinal study of consecutive newly referred patients with CKD ages 65 years, followed until the time of the first event (ESRD or death), using a competing-risk analysis. A modified Charlson Comorbidity Index (mCCI) was subdivided into subgroups (0-2, 3-4, 5). Patients were followed for hospitalizations that occurred prior to the outcomes. Among 416 patients, age 76 +/- 8 years, 52% male, median estimated glomerular filtration rate of 32mL/min per 1.73m(2), 50% had diabetes, and 67% cardiovascular disease. Over a median follow-up of 3.6 years, 36 patients progressed to ESRD (8.7%) and 103 died (24.8%). Older age (subdistribution HR (sHR)=1. 06; p<0.001), creatinine1.6mg/dL (sHR=2.03, p=0.004), hemoglobin <11g/dL (sHR=1.91, p=0.003), mCCI score5 (sHR=3.01, p<0.001) and having one or more hospitalizations (sHR=1.73, p<0.001) were associated with death before ESRD. The independent predictors for ESRD with competing risk of death were: lower age (sHR=0.94; p=0.009), creatinine1.6mg/dL (sHR=3.26, p=0.006), hemoglobin <11g/dL (sHR=2.15, p=0.027), peripheral vascular disease (sHR=3.45, p=0.001) and having one or more hospitalizations (sHR=1.56, p=0.031). Elderly referred patients with CKD are near threefold more likely to die than progress to ESRD. A competing-risk framework based on available clinical and laboratory data may discriminate between those outcomes and could be used as a decision-making tool.

Language: English

Type (Professor's evaluation): Scientific

No. of pages: 8