PMID- 29688442
OWN - NLM
STAT- MEDLINE
DCOM- 20191023
LR  - 20191219
IS  - 1460-2385 (Electronic)
IS  - 0931-0509 (Print)
IS  - 0931-0509 (Linking)
VI  - 33
IP  - 10
DP  - 2018 Oct 1
TI  - Impact of residual kidney function on hemodialysis adequacy and patient survival.
PG  - 1823-1831
LID - 10.1093/ndt/gfy060 [doi]
AB  - BACKGROUND: Both dialysis dose and residual kidney function (RKF) contribute to 
      solute clearance and are associated with outcomes in hemodialysis patients. We 
      hypothesized that the association between dialysis dose and mortality is 
      attenuated with greater RKF. METHODS: Among 32 251 incident hemodialysis patients 
      in a large US dialysis organization (2007-11), we examined the interaction 
      between single-pool Kt/V (spKt/V) and renal urea clearance (rCLurea) levels in 
      survival analyses using multivariable Cox proportional hazards regression model. 
      RESULTS: The median rCLurea and mean baseline spKt/V were 3.06 [interquartile 
      range (IQR) 1.74-4.85] mL/min/1.73 m2 and 1.32 +/- 0.28, respectively. A total of 
      7444 (23%) patients died during the median follow-up of 1.2 years (IQR 
      0.5-2.2 years) with an incidence of 15.4 deaths per 100 patient-years. The Cox 
      model with adjustment for case-mix and laboratory variables showed that rCLurea 
      modified the association between spKt/V and mortality (Pinteraction = 0.03); 
      lower spKt/V was associated with higher mortality among patients with low rCLurea 
      (i.e. <3  mL/min/1.73 m2) but not among those with higher rCLurea. The adjusted 
      mortality hazard ratios (aHRs) and 95% confidence intervals of the low (<1.2) 
      versus high (>/=1.2) spKt/V were 1.40 (1.12-1.74), 1.21 (1.10-1.33), 1.06 
      (0.98-1.14), and 1.00 (0.93-1.08) for patients with rCLurea of 0.0, 1.0, 3.0 and 
      6.0 mL/min/1.73 m2, respectively. CONCLUSIONS: Incident hemodialysis patients 
      with substantial RKF do not exhibit the expected better survival at higher 
      hemodialysis doses. RKF levels should be taken into account when deciding on the 
      dose of dialysis treatment among incident hemodialysis patients.
FAU - Wang, Mengjing
AU  - Wang M
AD  - Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of 
      Nephrology and Hypertension, Department of Medicine, University of California 
      Irvine Medical Center, Orange, CA, USA.
AD  - Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan 
      University, Shanghai, China.
FAU - Obi, Yoshitsugu
AU  - Obi Y
AD  - Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of 
      Nephrology and Hypertension, Department of Medicine, University of California 
      Irvine Medical Center, Orange, CA, USA.
FAU - Streja, Elani
AU  - Streja E
AD  - Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of 
      Nephrology and Hypertension, Department of Medicine, University of California 
      Irvine Medical Center, Orange, CA, USA.
AD  - Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, 
      USA.
FAU - Rhee, Connie M
AU  - Rhee CM
AD  - Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of 
      Nephrology and Hypertension, Department of Medicine, University of California 
      Irvine Medical Center, Orange, CA, USA.
AD  - Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, 
      USA.
FAU - Chen, Jing
AU  - Chen J
AD  - Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan 
      University, Shanghai, China.
FAU - Hao, Chuanming
AU  - Hao C
AD  - Division of Nephrology, Department of Medicine, Huashan Hospital, Fudan 
      University, Shanghai, China.
FAU - Kovesdy, Csaba P
AU  - Kovesdy CP
AD  - Division of Nephrology, Department of Medicine, University of Tennessee Health 
      Science Center, Memphis, TN, USA.
AD  - Nephrology Section, Memphis VA Medical Center, Memphis, TN, USA.
FAU - Kalantar-Zadeh, Kamyar
AU  - Kalantar-Zadeh K
AD  - Harold Simmons Center for Kidney Disease Research and Epidemiology, Division of 
      Nephrology and Hypertension, Department of Medicine, University of California 
      Irvine Medical Center, Orange, CA, USA.
AD  - Nephrology Section, Tibor Rubin Veterans Affairs Medical Center, Long Beach, CA, 
      USA.
AD  - Fielding School of Public Health at UCLA, Los Angeles, CA, USA.
LA  - eng
GR  - K23 DK102903/DK/NIDDK NIH HHS/United States
GR  - K24 DK091419/DK/NIDDK NIH HHS/United States
PT  - Journal Article
PT  - Research Support, N.I.H., Extramural
PT  - Research Support, Non-U.S. Gov't
PL  - England
TA  - Nephrol Dial Transplant
JT  - Nephrology, dialysis, transplantation : official publication of the European 
      Dialysis and Transplant Association - European Renal Association
JID - 8706402
SB  - IM
MH  - Female
MH  - Humans
MH  - Kidney/*physiopathology
MH  - Kidney Failure, Chronic/*mortality/*physiopathology/therapy
MH  - Kidney Function Tests
MH  - Male
MH  - Middle Aged
MH  - Prognosis
MH  - Renal Dialysis/*mortality
MH  - Survival Rate
PMC - PMC6888034
EDAT- 2018/04/25 06:00
MHDA- 2019/10/24 06:00
PMCR- 2019/04/23
CRDT- 2018/04/25 06:00
PHST- 2017/10/16 00:00 [received]
PHST- 2018/02/21 00:00 [accepted]
PHST- 2018/04/25 06:00 [pubmed]
PHST- 2019/10/24 06:00 [medline]
PHST- 2018/04/25 06:00 [entrez]
PHST- 2019/04/23 00:00 [pmc-release]
AID - 4975843 [pii]
AID - gfy060 [pii]
AID - 10.1093/ndt/gfy060 [doi]
PST - ppublish
SO  - Nephrol Dial Transplant. 2018 Oct 1;33(10):1823-1831. doi: 10.1093/ndt/gfy060.