Among patients initiating dialysis, mortality is higher for those with a primary indication of volume overload or hypertension, suggests a study in the American Journal of Kidney Diseases.
The retrospective analysis included 461 patients who initiated hemodialysis or peritoneal dialysis (24 patients) from 2004 through 2012 at 14 facilities. All-cause mortality was analyzed for patients with differing primary indications for dialysis initiation: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload, hypertension, or “other/unknown.”
At a median follow-up of 2.4 years, 40% percent of patients had died. Crude mortality was 21.7 per 100 patient-years for patients with volume overload or hypertension, compared to 10.0 for those with kidney function decline, 12.7 with uremic symptoms, and 12.2 for the “other/unknown” category.
On adjusted analysis, volume overload or hypertension was the only category associated with increased mortality: hazard ratio 1.69. Among patients using a permanent dialysis access, the risk of death was eight times higher for those in the volume overload/hypertension group, compared to those with decreased kidney function.
The results suggest increased mortality among patients initiating dialysis due to volume overload, relative to those with laboratory evidence of kidney function decline. The researchers write: “Improved understanding of symptoms and clinical decision making at the time of the transition to dialysis therapy has the potential to lead to innovation in identifying the optimal timing for the initiation of maintenance dialysis therapy” [Rivara MB, et al. Indication for dialysis initiation and mortality in patients with chronic kidney failure: a retrospective cohort study. Am J Kidney Dis 2017; 69:41–50].