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1. Clinical triage of patients on kidney replacement therapy presenting with COVID-19: An ERACODA registry analysis

Author

Mitra, S., Jayanti, A., Vart, P., Coca, A., Gallieni, M., Ovrehus, M. A., Midtvedt, K., Abd Elhafeez, S., Gandolfini, I., Buttner, S., Franssen, C. F. M., Hemmelder, M. H., Van Der Net, J. B., Essig, M., Du Buf-Vereijken, P. W. G., Van Ginneken, B., Maas, N., Vogt, L., Van Jaarsveld, B. C., Jager, K. J., Bemelman, F. J., Klingenberg-Salahova, F., Heenan-Vos, F., Vervloet, M. G., Nurmohamed, A., Abramowicz, D., Verhofstede, S., Maoujoud, O., Malfait, T., Fialova, J., Melilli, E., Fava, A., Cruzado, J. M., Perez, N. M., Lips, J., Krepel, H., Adilovic, H., Hengst, M., Rydzewski, A., Gellert, R., Oliveira, J., Alferes, D. G., Zakharova, E. V., Ambuehl, P. M., Walker, A., Winzeler, R., Lepeytre, F., Rabate, C., Rostoker, G., Marques, S., Azasevac, T., Katicic, D., Dam, M. T., Kruger, T., Brzosko, S., Zanen, A. L., Logtenberg, S. J. J., Fricke, L., Slebe, J. J. P., Kemlin, D., Van De Wetering, J., Reinders, M. E. J., Eiselt, J., Kielberger, L., El-Wakil, H. S., Verhoeven, M. A. M., Canal, C., Facundo, C., Ramos, A. M., Debska-Slizien, A., Veldhuizen, N. M. H., Tigka, E., Konsta, M. A. P., Panagoutsos, S., Mallamaci, F., Postorino, A., Cambareri, F., Covic, A., Matceac, I., Nistor, I., Cordos, M., Groeneveld, J. H. M., Jousma, J., Marjolijn Van Buren, Diekmann, F., Tiago Assis Pereira, Santos, A. C. S., Arias-Cabrales, C., Crespo, M., Llinas-Mallol, L., Buxeda, A., Tarrega, C. B., Redondo-Pachon, D., Jimenez, M. D. A., Hofstra, J. M., Franco, A., Arroyo, D., Rodriguez-Ferrero, M. L., Manzanos, S. B., Barrios, R. H. S., Avila, G., Laranjinha, I., Mateus, C., Lemahieu, W., Bartelet, K., Dirim, A. B., Sever, M. S., Demir, E., Safak, S., Turkmen, A., Hollander, D. A. M. J., De Vries, A. P. J., Meziyerh, S., Van Der Helm, D., Mallat, M., Bouwsma, H., Sridharan, S., Petruliene, K., Maloney, S. -R., Verberk, I., Van Der Sande, F. M., Christiaans, M. H. L., Mohankumar, N., Di Luca, M., Tuglular, S. Z., Kramer, A., Beerenhout, C., Luik, P. T., Kerschbaum, J., Tiefenthaler, M., Watschinger, B., Adema, A. Y., Stepanov, V. A., Zulkarnaev, A. B., Turkmen, K., Fliedner, A., Asberg, A., Mjoen, G., Miyasato, H., De Fijter, C. W. H., Mongera, N., Pini, S., De Biase, C., Duivenvoorden, R., Hilbrands, L., Kerckhoffs, A., Van De Logt, A. -E., Maas, R., Lebedeva, O., Lopez, V., Verhave, J., Reichert, L. J. M., Titov, D., Parshina, E. V., Zanoli, L., Marcantoni, C., Van Gils-Verrij, L. E. A., Harty, J. C., Meurs, M., Myslak, M., Battaglia, Y., Lentini, P., Den Deurwaarder, E., Stendahl, M., Rahimzadeh, H., Schouten, M., Rychlik, I., Cabezas-Reina, C. J., Roca, A. M., Nauta, F., Goffin, E., Kanaan, N., Labriola, L., Devresse, A., Diaz-Mareque, A., Meijers, B. K. I., Naesens, M., Kuypers, D., Desschans, B., Tonnelier, A., Wissing, K. M., De Arriba, G., Dedinska, I., Pessolano, G., Maggiore, U., Malik, S., Papachristou, E., Gansevoort, R. T., Noordzij, M., Berger, S. P., Meijer, E., Ozyilmaz, A., Sanders, J. S. F., Ponikvar, J. B., Arnol, M., Pernat, A. M., Kovac, D., Ekart, R., Abrahams, A. C., Molenaar, F. M., Van Zuilen, A. D., Meijvis, S. C. A., Dolmans, H., Tantisattamo, E., Esposito, P., Krzesinski, J. -M., Barahira, J. D., Sabiu, G., Martin-Moreno, P. L., Guglielmetti, G., Guzzo, G., Toapanta, N., Soler, M. J., Luik, A. J., Van Kuijk, W. H. M., Stikkelbroeck, L. W. H., Hermans, M. M. H., Rimsevicius, L., Righetti, M., Islam, M., Braak, N. H. -T., Nephrology, UCL - SSS/IREC/NEFR - Pôle de Néphrologie, UCL - (SLuc) Service de néphrologie, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Groningen Kidney Center (GKC), ACS - Diabetes & metabolism, AII - Inflammatory diseases, AII - Infectious diseases, Internal Medicine, and Clinical sciences

Subjects
kidney, medicine.medical_specialty, Coronavirus disease 2019 (COVID-19), medicine.medical_treatment, Pulmonary insufficiency, infectious diseases, Kidney, Second presentation, Interquartile range, Internal medicine, medicine, Humans, Registries, Mortality, AcademicSubjects/MED00340, Dialysis, Aged, Transplantation, second presentation, business.industry, SARS-CoV-2, COVID-19, medicine.disease, mortality, Triage, Hospitalization, Renal Replacement Therapy, Renal disorders Radboud Institute for Molecular Life Sciences [Radboudumc 11], Nephrology, Oxygen Saturation, dialysis, Original Article, Hemodialysis, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], Presentation (obstetrics), business, transplantation
Abstract

Background Patients on kidney replacement therapy (KRT) are at very high risk of coronavirus disease 2019 (COVID-19). The triage pathway for KRT patients presenting to hospitals with varying severity of COVID-19 illness remains ill-defined. We studied the clinical characteristics of patients at initial and subsequent hospital presentations and the impact on patient outcomes. Methods The European Renal Association COVID-19 Database (ERACODA) was analysed for clinical and laboratory features of 1423 KRT patients with COVID-19 either hospitalized or non-hospitalized at initial triage and those re-presenting a second time. Predictors of outcomes (hospitalization, 28-day mortality) were then determined for all those not hospitalized at initial triage. Results Among 1423 KRT patients with COVID-19 [haemodialysis (HD), n = 1017; transplant, n = 406), 25% (n = 355) were not hospitalized at first presentation due to mild illness (30% HD, 13% transplant). Of the non-hospitalized patients, only 10% (n = 36) re-presented a second time, with a 5-day median interval between the two presentations (interquartile range 2–7 days). Patients who re-presented had worsening respiratory symptoms, a decrease in oxygen saturation (97% versus 90%) and an increase in C-reactive protein (26 versus 73 mg/L) and were older (72 vs 63 years) compared with those who did not return a second time. The 28-day mortality between early admission (at first presentation) and deferred admission (at second presentation) was not significantly different (29% versus 25%; P = 0.6). Older age, prior smoking history, higher clinical frailty score and self-reported shortness of breath at first presentation were identified as risk predictors of mortality when re-presenting after discharge at initial triage. Conclusions This study provides evidence that KRT patients with COVID-19 and mild illness can be managed effectively with supported outpatient care and with vigilance of respiratory symptoms, especially in those with risk factors for poor outcomes. Our findings support a risk-stratified clinical approach to admissions and discharges of KRT patients presenting with COVID-19 to aid clinical triage and optimize resource utilization during the ongoing pandemic.

Published
2021

2. Measures of chronic kidney disease and risk of incident peripheral artery disease: a collaborative meta-analysis of individual participant data

Author

Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, Js, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Jh, Ix, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, As, Chen, J, Kwak, L, Sang, Y., Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Matsushita, K, Ballew, Sh, Coresh, J, Arima, H, Ärnlöv, J, Cirillo, Massimo, Ebert, N, Hiramoto, J, Kimm, H, Shlipak, Mg, Visseren, Flj, Gansevoort, Rt, Kovesdy, Cp, Shalev, V, Woodward, M, Kronenberg, F, Chronic Kidney Disease Prognosis Consortium: Chalmers, J, Perkovic, V, Grams, Me, Sang, Y, Schaeffner, E, Martus, P, Levin, A, Djurdjev, O, Tang, M, Heine, G, Seiler, S, Zawada, A, Emrich, I, Sarnak, M, Katz, R, Brenner, H, Schöttker, B, Rothenbacher, D, Saum, Ku, Köttgen, A, Schneider, M, Eckardt, Ku, Green, J, Kirchner, Hl, Chang, Ar, Black, C, Marks, A, Prescott, G, Clark, L, Fluck, N, Jee, Sh, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Ad, Bots, M, Peralta, C, Hiromoto, J, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Kenealy, T, Elley, Cr, Collins, Jf, Drury, Pl, Bakker, Sj, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett Connor, E, Kalantar Zadeh, K, Carrero, Jj, Gasparini, A, Qureshi, Ar, Barany, P, Algra, A, Van, Der, Graaf, Y, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Lannfelt, L, Larsson, A, Hallan, S, Levey, A, Chen, J, Kwak, L, and Sang, Y.

Subjects
Male, Databases, Factual, Endocrinology, Diabetes and Metabolism, nefropatia, arteriopatia periferica, epidemiologia, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, arteriopatia periferica, 0302 clinical medicine, Endocrinology, Risk Factors, CRITICAL LIMB ISCHEMIA, 030212 general & internal medicine, epidemiologia, POPULATION, biology, CYSTATIN C, Incidence, Middle Aged, PREVALENCE, Diabetes and Metabolism, nefropatia, Creatinine, Female, medicine.symptom, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Renal function, ATHEROSCLEROSIS RISK, HEART-ASSOCIATION, CARDIOVASCULAR OUTCOMES, 03 medical and health sciences, Peripheral Arterial Disease, Internal medicine, Diabetes mellitus, medicine, Internal Medicine, Albuminuria, Humans, Risk factor, Renal Insufficiency, Chronic, Aged, business.industry, Critical limb ischemia, medicine.disease, Intermittent claudication, Surgery, Cystatin C, biology.protein, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

BACKGROUND: Some evidence suggests that chronic kidney disease is a risk factor for lower-extremity peripheral artery disease. We aimed to quantify the independent and joint associations of two measures of chronic kidney disease (estimated glomerular filtration rate [eGFR] and albuminuria) with the incidence of peripheral artery disease.METHODS: In this collaborative meta-analysis of international cohorts included in the Chronic Kidney Disease Prognosis Consortium (baseline measurements obtained between 1972 and 2014) with baseline measurements of eGFR and albuminuria, at least 1000 participants (this criterion not applied to cohorts exclusively enrolling patients with chronic kidney disease), and at least 50 peripheral artery disease events, we analysed adult participants without peripheral artery disease at baseline at the individual patient level with Cox proportional hazards models to quantify associations of creatinine-based eGFR, urine albumin-to-creatinine ratio (ACR), and dipstick proteinuria with the incidence of peripheral artery disease (including hospitalisation with a diagnosis of peripheral artery disease, intermittent claudication, leg revascularisation, and leg amputation). We assessed discrimination improvement through c-statistics.FINDINGS: We analysed 817 084 individuals without a history of peripheral artery disease at baseline from 21 cohorts. 18 261 cases of peripheral artery disease were recorded during follow-up across cohorts (median follow-up was 7·4 years [IQR 5·7-8·9], range 2·0-15·8 years across cohorts). Both chronic kidney disease measures were independently associated with the incidence of peripheral artery disease. Compared with an eGFR of 95 mL/min per 1·73 m(2), adjusted hazard ratios (HRs) for incident study-specific peripheral artery disease was 1·22 (95% CI 1·14-1·30) at an eGFR of 45 mL/min per 1·73 m(2) and 2·06 (1·70-2·48) at an eGFR of 15 mL/min per 1·73 m(2). Compared with an ACR of 5 mg/g, the adjusted HR for incident study-specific peripheral artery disease was 1·50 (1·41-1·59) at an ACR of 30 mg/g and 2·28 (2·12-2·44) at an ACR of 300 mg/g. The adjusted HR at an ACR of 300 mg/g versus 5 mg/g was 3·68 (95% CI 3·00-4·52) for leg amputation. eGFR and albuminuria contributed multiplicatively (eg, adjusted HR 5·76 [4·90-6·77] for incident peripheral artery disease and 10·61 [5·70-19·77] for amputation in eGFR INTERPRETATION: Even mild-to-moderate chronic kidney disease conferred increased risk of incident peripheral artery disease, with a strong association between albuminuria and amputation. Clinical attention should be paid to the development of peripheral artery disease symptoms and signs in people with any stage of chronic kidney disease.FUNDING: American Heart Association, US National Kidney Foundation, and US National Institute of Diabetes and Digestive and Kidney Diseases.

Published
2017

3. Adiposity and risk of decline in glomerular filtration rate : Meta-analysis of individual participant data in a global consortium

Author

Chang AR, Grams ME, Ballew SH, Bilo H, Correa A, Evans M, Gutierrez OM, Hosseinpanah F, Iseki K, Kenealy T, Klein B, Kronenberg F, Lee BJ, Li Y, Miura K, Navaneethan SD, Roderick PJ, Valdivielso JM, Visseren FLJ, Zhang L, Gansevoort RT, Hallan SI, Levey AS, Matsushita K, Shalev V, Woodward M, Astor B, Appel L, Greene T, Chen T, Chalmers J, Arima H, Perkovic V, Yatsuya H, Tamakoshi K, Hirakawa Y, Coresh J, Sang Y, Polkinghorne K, Chadban S, Atkins R, Levin A, Djurdjev O, Klein R, Lee K, Liu L, Zhao M, Wang F, Wang J, Tang M, Heine G, Emrich I, Zawada A, Bauer L, Nally J, Schold J, Shlipak M, Sarnak M, Katz R, Hiramoto J, Iso H, Yamagishi K, Umesawa M, Muraki I, Fukagawa M, Maruyama S, Hamano T, Hasegawa T, Fujii N, Jafar T, Hatcher J, Poulter N, Chaturvedi N, Wheeler D, Emberson J, Townend J, Landray M, Brenner H, Schöttker B, Saum KU, Rothenbacher D, Fox C, Hwang SJ, Köttgen A, Schneider MP, Eckardt KU, Green J, Kirchner HL, Ito S, Miyazaki M, Nakayama M, Yamada G, Cirillo M, Romundstad S, Øvrehus M, Langlo KA, Irie F, Sairenchi T, Rebholz CM, Young B, Boulware LE, Ishikawa S, Yano Y, Kotani K, Nakamura T, Jee SH, Kimm H, Mok Y, Chodick G, Wetzels JFM, Blankestijn PJ, van Zuilen AD, Bots M, Inker L, Peralta C, Kollerits B, Ritz E, Nitsch D, Fletcher A, Bottinger E, Nadkarni GN, Ellis SB, Nadukuru R, Fernandez E, Betriu A, Bermudez-Lopez M, Stengel B, Metzger M, Flamant M, Houillier P, Haymann JP, Froissart M, Ueshima H, Okayama A, Tanaka S, Okamura T, Elley CR, Collins JF, Drury PL, Ohkubo T, Asayama K, Metoki H, Kikuya M, Iseki C, Nelson RG, Knowler WC, Bakker SJL, Heerspink HJL, Brunskill N, Major R, Shepherd D, Medcalf J, Jassal SK, Bergstrom J, Ix JH, Barrett-Connor E, Kovesdy C, Kalantar-Zadeh K, Sumida K, Muntner P, Warnock D, Judd S, Panwar B, de Zeeuw D, Brenner B, Sedaghat S, Ikram MA, Hoorn EJ, Dehghan A, Wong TY, Sabanayagam C, Cheng CY, Banu R, Segelmark M, Stendahl M, Schön S, Tangri N, Sud M, Naimark D, Wen CP, Tsao CK, Tsai MK, Chen CH, Konta T, Hirayama A, Ichikawa K, Hadaegh F, Mirbolouk M, Azizi F, Solbu MD, Jenssen TG, Eriksen BO, Eggen AE, Lannfelt L, Larsson A, Ärnlöv J, Landman GWD, van Hateren KJJ, Kleefstra N, Chen J, Kwak L, Surapaneni A., Chang, Ar, Grams, Me, Ballew, Sh, Bilo, H, Correa, A, Evans, M, Gutierrez, Om, Hosseinpanah F, Iseki K, Kenealy, T, Klein, B, Kronenberg, F, Lee, Bj, Li, Y, Miura, K, Navaneethan, Sd, Roderick, Pj, Valdivielso, Jm, Visseren, Flj, Zhang, L, Gansevoort, Rt, Hallan, Si, Levey, A, Matsushita, K, Shalev, V, Woodward, M, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Arima, H, Perkovic, V, Yatsuya, H, Tamakoshi, K, Hirakawa, Y, Coresh, J, Sang, Y, Polkinghorne, K, Chadban, S, Atkins, R, Levin, A, Djurdjev, O, Klein, R, Lee, K, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Heine, G, Emrich, I, Zawada, A, Bauer, L, Nally, J, Schold, J, Shlipak, M, Sarnak, M, Katz, R, Hiramoto, J, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Hasegawa, T, Fujii, N, Jafar, T, Hatcher, J, Poulter, N, Chaturvedi, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Brenner, H, Schöttker, B, Saum, Ku, Rothenbacher, D, Fox, C, Hwang, Sj, Köttgen, A, Schneider, Mp, Eckardt, Ku, Green, J, Kirchner, Hl, Ito, S, Miyazaki, M, Nakayama, M, Yamada, G, Cirillo, M, Romundstad, S, Øvrehus, M, Langlo, Ka, Irie, F, Sairenchi, T, Rebholz, Cm, Young, B, Boulware, Le, Ishikawa, S, Yano, Y, Kotani, K, Nakamura, T, Jee, Sh, Kimm, H, Mok, Y, Chodick, G, Wetzels, Jfm, Blankestijn, Pj, van Zuilen, Ad, Bots, M, Inker, L, Peralta, C, Kollerits, B, Ritz, E, Nitsch, D, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Fernandez, E, Betriu, A, Bermudez-Lopez, M, Stengel, B, Metzger, M, Flamant, M, Houillier, P, Haymann, Jp, Froissart, M, Ueshima, H, Okayama, A, Tanaka, S, Okamura, T, Elley, Cr, Collins, Jf, Drury, Pl, Ohkubo, T, Asayama, K, Metoki, H, Kikuya, M, Iseki, C, Nelson, Rg, Knowler, Wc, Bakker, Sjl, Heerspink, Hjl, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, Sumida, K, Muntner, P, Warnock, D, Judd, S, Panwar, B, de Zeeuw, D, Brenner, B, Sedaghat, S, Ikram, Ma, Hoorn, Ej, Dehghan, A, Wong, Ty, Sabanayagam, C, Cheng, Cy, Banu, R, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Hirayama, A, Ichikawa, K, Hadaegh, F, Mirbolouk, M, Azizi, F, Solbu, Md, Jenssen, Tg, Eriksen, Bo, Eggen, Ae, Lannfelt, L, Larsson, A, Ärnlöv, J, Landman, Gwd, van Hateren, Kjj, Kleefstra, N, Chen, J, Kwak, L, Surapaneni, A., Lifestyle Medicine (LM), Cardiovascular Centre (CVC), Groningen Kidney Center (GKC), Groningen Institute for Organ Transplantation (GIOT), Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Asayama, Kei, and Sedaghat, SeyyedMah

Subjects
CHRONIC KIDNEY-DISEASE, Male, 030232 urology & nephrology, 030204 cardiovascular system & hematology, OBESITY PARADOX, Body Mass Index, BMI, eGFR, CKD-PC, Cohort Studies, 0302 clinical medicine, Risk Factors, Urologi och njurmedicin, Medicine, ALL-CAUSE MORTALITY, Adiposity, 2. Zero hunger, Aged, 80 and over, Medicine(all), education.field_of_study, Hazard ratio, ASSOCIATION, General Medicine, Middle Aged, 3. Good health, Cohort, Female, Waist Circumference, Life Sciences & Biomedicine, WAIST CIRCUMFERENCE, Obesity paradox, Glomerular Filtration Rate, Adult, Waist, Population, Renal function, 03 medical and health sciences, Medicine, General & Internal, General & Internal Medicine, CKD, Urology and Nephrology, Humans, Mortality, education, Aged, Science & Technology, business.industry, Research, medicine.disease, Body Height, BODY-MASS INDEX, Kidney Failure, Chronic, WEIGHT, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Body mass index, Demography, Kidney disease
Abstract

ObjectiveTo evaluate the associations between adiposity measures (body mass index, waist circumference, and waist-to-height ratio) with decline in glomerular filtration rate (GFR) and with all cause mortality.DesignIndividual participant data meta-analysis.SettingCohorts from 40 countries with data collected between 1970 and 2017.ParticipantsAdults in 39 general population cohorts (n=5 459 014), of which 21 (n=594 496) had data on waist circumference; six cohorts with high cardiovascular risk (n=84 417); and 18 cohorts with chronic kidney disease (n=91 607).Main outcome measuresGFR decline (estimated GFR decline ≥40%, initiation of kidney replacement therapy or estimated GFR 2) and all cause mortality.ResultsOver a mean follow-up of eight years, 246 607 (5.6%) individuals in the general population cohorts had GFR decline (18 118 (0.4%) end stage kidney disease events) and 782 329 (14.7%) died. Adjusting for age, sex, race, and current smoking, the hazard ratios for GFR decline comparing body mass indices 30, 35, and 40 with body mass index 25 were 1.18 (95% confidence interval 1.09 to 1.27), 1.69 (1.51 to 1.89), and 2.02 (1.80 to 2.27), respectively. Results were similar in all subgroups of estimated GFR. Associations weakened after adjustment for additional comorbidities, with respective hazard ratios of 1.03 (0.95 to 1.11), 1.28 (1.14 to 1.44), and 1.46 (1.28 to 1.67). The association between body mass index and death was J shaped, with the lowest risk at body mass index of 25. In the cohorts with high cardiovascular risk and chronic kidney disease (mean follow-up of six and four years, respectively), risk associations between higher body mass index and GFR decline were weaker than in the general population, and the association between body mass index and death was also J shaped, with the lowest risk between body mass index 25 and 30. In all cohort types, associations between higher waist circumference and higher waist-to-height ratio with GFR decline were similar to that of body mass index; however, increased risk of death was not associated with lower waist circumference or waist-to-height ratio, as was seen with body mass index.ConclusionsElevated body mass index, waist circumference, and waist-to-height ratio are independent risk factors for GFR decline and death in individuals who have normal or reduced levels of estimated GFR.

Published
2019

4. Serum potassium and adverse outcomes across the range of kidney function: a CKD Prognosis Consortium meta-analysis

Author

Kovesdy, CP, Matsushita, K, Sang, Y, Brunskill, NJ, Carrero, JJ, Chodick, G, Hasegawa, T, Heerspink, HL, Hirayama, A, Landman, GWD, Levin, A, Nitsch, D, Wheeler, DC, Coresh, J, Hallan, SI, Shalev, V, Grams, ME, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Woodward, M, Arima, H, Perkovic, V, Djurdjev, O, Zhang, L, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Fujii, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Green, J, Kirchner, HL, Chang, AR, Cirillo, Massimo, Jee, SH, Kimm, H, Mok, Y, Wetzels, JFM, Blankestijn, PJ, van Zuilen, Bots, M, Sarnak, M, Inker, L, Roderick, P, Fletcher, A, Bottinger, E, Nadkarni, GN, Ellis, SB, Nadukuru, R, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Gansevoort, RT, Bakker, SJL, Heerspink, HJL, Jassal, SK, Bergstrom, J, Ix, JH, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, de Zeeuw, D, Brenner, B, Gasparini, A, Elinder, CG, Barany, P, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, CP, Tsao, CK, Tsai, MK, Chen, CH, Konta, T, Ichikawa, K, Bilo, HJG, van Hateren, KJJ, Kleefstra, N, Hallan, S, Levey, AS, Ballew, SH, Chen, J, Kwak, L, Woodward, M., Kovesdy, Cp, Matsushita, K, Sang, Y, Brunskill, Nj, Carrero, Jj, Chodick, G, Hasegawa, T, Heerspink, Hl, Hirayama, A, Landman, Gwd, Levin, A, Nitsch, D, Wheeler, Dc, Coresh, J, Hallan, Si, Shalev, V, Grams, Me, Astor, B, Appel, L, Greene, T, Chen, T, Chalmers, J, Woodward, M, Arima, H, Perkovic, V, Djurdjev, O, Zhang, L, Liu, L, Zhao, M, Wang, F, Wang, J, Tang, M, Iso, H, Yamagishi, K, Umesawa, M, Muraki, I, Fukagawa, M, Maruyama, S, Hamano, T, Fujii, N, Wheeler, D, Emberson, J, Townend, J, Landray, M, Green, J, Kirchner, Hl, Chang, Ar, Cirillo, Massimo, Jee, Sh, Kimm, H, Mok, Y, Wetzels, Jfm, Blankestijn, Pj, Van, Zuilen, Ad, Bots, M, Sarnak, M, Inker, L, Roderick, P, Fletcher, A, Bottinger, E, Nadkarni, Gn, Ellis, Sb, Nadukuru, R, Brunskill, N, Major, R, Shepherd, D, Medcalf, J, Gansevoort, Rt, Bakker, Sjl, Heerspink, Hjl, Jassal, Sk, Bergstrom, J, Ix, Jh, Barrett-Connor, E, Kovesdy, C, Kalantar-Zadeh, K, De, Zeeuw, D, Brenner, B, Gasparini, A, Elinder, Cg, Barany, P, Evans, M, Segelmark, M, Stendahl, M, Schön, S, Tangri, N, Sud, M, Naimark, D, Wen, Cp, Tsao, Ck, Tsai, Mk, Chen, Ch, Konta, T, Ichikawa, K, Bilo, Hjg, Van, Hateren, Kjj, Kleefstra, N, Hallan, S, Levey, A, Ballew, Sh, Chen, J, Kwak, L, Woodward, M., Real World Studies in PharmacoEpidemiology, -Genetics, -Economics and -Therapy (PEGET), Groningen Kidney Center (GKC), and Methods in Medicines evaluation & Outcomes research (M2O)

Subjects
Hyperkalemia, 030232 urology & nephrology, HEMODIALYSIS-PATIENTS, Comorbidity, 030204 cardiovascular system & hematology, GLOMERULAR-FILTRATION-RATE, HYPERKALEMIA, End-stage renal disease, CHRONIC RENAL-INSUFFICIENCY, 0302 clinical medicine, SODIUM ZIRCONIUM CYCLOSILICATE, Risk Factors, Cause of Death, Estimated glomerular filtration rate, ESTIMATED GFR, education.field_of_study, Hazard ratio, Middle Aged, Prognosis, CHRONIC HEART-FAILURE, EUROPEAN-SOCIETY, Cardiovascular Diseases, medicine.symptom, Cardiology and Cardiovascular Medicine, Glomerular Filtration Rate, Adult, medicine.medical_specialty, Population, Renal function, Hypokalemia, End stage renal disease, 03 medical and health sciences, Internal medicine, medicine, Humans, Albuminuria, Renal Insufficiency, Chronic, Mortality, education, CKD Prognosis Consortium, Aged, business.industry, Proportional hazards model, POLYMERIC POTASSIUM BINDER, medicine.disease, SERUM POTASSIUM, Potassium, Kidney Failure, Chronic, Renal disorders Radboud Institute for Health Sciences [Radboudumc 11], business, Kidney disease
Abstract

Item does not contain fulltext Aims: Both hypo- and hyperkalaemia can have immediate deleterious physiological effects, and less is known about long-term risks. The objective was to determine the risks of all-cause mortality, cardiovascular mortality, and end-stage renal disease associated with potassium levels across the range of kidney function and evaluate for consistency across cohorts in a global consortium. Methods and results: We performed an individual-level data meta-analysis of 27 international cohorts [10 general population, 7 high cardiovascular risk, and 10 chronic kidney disease (CKD)] in the CKD Prognosis Consortium. We used Cox regression followed by random-effects meta-analysis to assess the relationship between baseline potassium and adverse outcomes, adjusted for demographic and clinical characteristics, overall and across strata of estimated glomerular filtration rate (eGFR) and albuminuria. We included 1 217 986 participants followed up for a mean of 6.9 years. The average age was 55 +/- 16 years, average eGFR was 83 +/- 23 mL/min/1.73 m2, and 17% had moderate- to-severe increased albuminuria levels. The mean baseline potassium was 4.2 +/- 0.4 mmol/L. The risk of serum potassium of >5.5 mmol/L was related to lower eGFR and higher albuminuria. The risk relationship between potassium levels and adverse outcomes was U-shaped, with the lowest risk at serum potassium of 4-4.5 mmol/L. Compared with a reference of 4.2 mmol/L, the adjusted hazard ratio for all-cause mortality was 1.22 [95% confidence interval (CI) 1.15-1.29] at 5.5 mmol/L and 1.49 (95% CI 1.26-1.76) at 3.0 mmol/L. Risks were similar by eGFR, albuminuria, renin-angiotensin-aldosterone system inhibitor use, and across cohorts. Conclusions: Outpatient potassium levels both above and below the normal range are consistently associated with adverse outcomes, with similar risk relationships across eGFR and albuminuria.

Published
2018

5. Supplemented ERA-EDTA Registry data evaluated the frequency of dialysis, kidney transplantation, and comprehensive conservative management for patients with kidney failure in Europe

Author

Pablo Castro de la Nuez, Ángela Magaz, Harijs Cernevskis, Arjan van der Tol, Kirill Komissarov, Maria Fernanda Slon Roblero, Edita Ziginskiene, Nino Kantaria, Manuela Savino, Jaakko Helve, Kyriakos Ioannou, Olivera Stojceva-Taneva, Kitty J Jager, Johan De Meester, Helena Rydell, Mai Ots-Rosenberg, Faical Jarraya, Myftar Barbullushi, Bjørn Odvar Eriksen, Rianne W de Jong, Cécile Couchoud, Axel Rahmel, Samira Bell, Lucile Mercadal, Eliezer Golan, Marc H Hemmelder, José Baltar, Anton M. Andrusev, Vianda S. Stel, Nurhan Seyahi, Anneke Kramer, Julia Kerschbaum, Liliana Gârneaţă, Ziad A. Massy, Kristine Hommel, Runolfur Palsson, Evgueniy Vazelov, Oscar Zurriaga, Raymond Vanholder, HUS Abdominal Center, Nefrologian yksikkö, Department of Medicine, University of Helsinki, Helsinki University Hospital Area, Interne Geneeskunde, RS: Carim - V02 Hypertension and target organ damage, Agence de la biomédecine [Saint-Denis la Plaine], Centre de recherche en épidémiologie et santé des populations (CESP), Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université Paris-Saclay, Service de néphrologie [CHU Pitié-Salpêtrière], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-CHU Pitié-Salpêtrière [AP-HP], Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU), Hôpital Ambroise Paré [AP-HP], Recycled Materials Resource Center, RMRC Comunidad de Madrid Sociedad Española de Nefrología, SEN European Commission, EC: PP-01-2016 Universidade Paranaense, UNIPAR European Renal Association-European Dialysis and Transplant Association, ERA-EDTA, The authors would like to thank the patients and staff of all the dialysis and transplant units who have contributed data via their national and regional renal registries to the European Renal Association?European Dialysis and Transplant Association (ERA-EDTA) Registry. In addition, we would like to thank the persons and organizations listed in the paragraph ?AFFILIATED REGISTRIES? for their contribution to the work of the ERA-EDTA Registry. The authors are grateful to all nephrologists and kidney transplant surgeons who completed ?The Effect of Differing Kidney Disease Treatment Modalities and Organ Donation and Transplantation Practices on Health Expenditure and Patient Outcomes? Nephrologist survey. In addition, we would like to thank all colleagues who pretested the survey, provided advice about the ethical approval in their country, or helped to distribute the survey in their country or personal network. This study was funded by the European Union (grant PP-01-2016) and ERA-EDTA. Among others, we are grateful for support from Austria (R. Kramar and R. Oberbauer), Belarus, Belgium (F. Collart), Croatia (I. Bubic, M. Bu?i?, M. Dragovi?, and S. ?iv?i? ?osi?), Cyprus, Czech Republic (I. Rychlik and V. Tesa?), Denmark (J. Heaf and S. Schwartz S?rensen), Estonia, Finland (P. Finne and V. Rauta), Germany (M. Lingemann and C. Wanner), Greece (T. Apostolou, E. Dounousi, and G. Moustakas), Hungary (O. Deme, S. Mihaly, and G. Re?sz), Ireland (W. Plant), Italy (G. Brunori, C. Carella, P. di Ciaccio, and M. Postorino), Latvia (A. Petersons), Malta (J. Buttigieg), Moldova (A. Tanase), the Netherlands (F. van Ittersum and S. Logtenberg), North Macedonia (G. Spasovski), Norway (A. ?sberg, M. Dahl Solbu, and A. Varberg Reis?ter), Poland (S. Dudzicz and M. Nowicki), Romania (L. G?rnea?? and L. Tuta), Russia (H. Zakharova), Serbia (R. Naumovic), Slovakia (V. Spustova), Slovenia (J. Buturovic Ponikvar and D. Kovac), Spain (C. Alberich, J. Comas, M. del Pino y Pino, M. Ferrer Alamar, and B. Mahillo), Sweden (M. Evans), Switzerland (P. Amb?hl and U. Huynh-Do), Turkey (M. Arici), Ukraine (M. Kolesnyk), and United Kingdom (S. Fraser and G. Lipkin), and from the following organizations: EKITA (I. Bellini and R. Langer), ERA-EDTA (F. Trebelli), EuroPD (S. Davies), and Eurotransplant (P. Branger, M. van Meel, and U. Samuel). Affiliated registries. Albanian Renal Registry (M. Barbullushi, A. Idrizi, and E. Bolleku Likaj), Austrian Dialysis and Transplant Registry (OEDTR) (R. Kramar), Belarus Renal Registry (K.S. Komissarov, K.S. Kamisarau, and A.V. Kalachyk), Dutch-speaking Belgian Society of Nephrology (NBVN) (M. Couttenye, F. Schroven, and J. De Meester), French-speaking Belgian Society of Nephrology (GNFB) (J.M. des Grottes and F. Collart), Renal Registry Bosnia and Herzegovina (H. Resi?, Z. Stipancic, and N. Petkovic), Bulgaria (E.S. Vazelov and I. Velinova), Croatian Registry of renal replacement therapy (CRRRT) (I. Bubi? and M. Knotek), Cyprus Renal Registry (K. Ioannou and all of the renal units providing data), Czech Republic: Registry of Dialysis Patients (RDP) (I. Rychl?k, J. Potucek, and F. Lopot), Danish Nephrology Registry (DNS) (J.G. Heaf), Estonian Society of Nephrology (?. Pechter, K. Lilienthal, and M. Rosenberg), Finnish Registry for Kidney Diseases (P. Finne, A. Pylsy, and P.H. Groop), France: The Epidemiology and Information Network in Nephrology (REIN) (M. Lassalle and C. Couchoud), Georgian Renal Registry (N. Kantaria and Dialysis Nephrology and Transplantation Union of Georgia), Hellenic Renal Registry (N. Afentakis), Icelandic ESRD Registry (R. Palsson), Israel National Registry of Renal Replacement Therapy (R. Dichtiar, T. Shohat, and E. Golan), Italian Registry of Dialysis and Transplantation (RIDT) (A. Limido, M. Nordio, and M. Postorino), Latvian Renal Registry (H. Cernevskis, V. Kuzema, and A. Silda), Lithuanian Renal Registry (I.A. Bumblyte, V. Vainauskas, and E. ?iginskien?), Macedonian Renal Registry (M. Nedelkovska, N. Dimitriova, and O. Stojceva-Taneva), Norwegian Renal Registry (T. Leivestad, A.V. Reis?ter, and A. ?sberg), Polish Renal Registry (G. Korejwo, A. D?bska-?lizie?, and R. Gellert), Portuguese Renal Registry (F. Mac?rio and A. Ferreira), Romanian Renal Registry (RRR) (G. Mircescu, L. Garneata, and E. Podgoreanu), Russian Renal Registry (N. Tomilina, A. Andrusev, and H. Zakharova), Renal Registry in Serbia (N. Maksimovic, R. Naumovic, all of the Serbian renal units, and the Serbian Society of Nephrology), Slovakian Renal Registry (V. Spustov?, I. Lajdov?, and M. Karolyova), Spanish RRT National Registry at Organizaci?n Nacional de Trasplantes (ONT), Spanish Regional Registries, Spanish Society of Nephrology (SEN), and the regional registries of Andalusia Sistema de Informaci?n de la Coordinaci?n Auton?mica de Trasplantes de Andalucia (SICATA) (P. Castro de la Nuez [on behalf of all users of SICATA]), Aragon (F. Arribas Monz?n, J.M. Abad Diez, and J.I. Sanchez Miret), Asturias (R. Alonso de la Torre, J.R. Quir?s, and Registro de Enfermos Renales Cr?nicos de Asturias [RERCA] Working Group), Basque country (UNIPAR) (?. Magaz, J. Aranzabal, M. Rodrigo, and I. Moina), Cantabria (J.C. Ruiz San Mill?n, O. Garcia Ruiz, and C. Pi?era Haces), Castile and Le?n (M.A. Palencia Garc?a), Castile?La Mancha (G. Guti?rrez ?vila and I. Moreno Al?a), Catalonia (RMRC) (E. Arcos, J. Comas, and J. Tort), Extremadura (J.M. Ramos Aceitero and M.A. Garc?a Bazaga), Galicia (E. Bouzas-Caama?o), Community of Madrid (M.I. Aparicio de Madre), Renal Registry of the Region of Murcia (C. Santiuste de Pablos and I. Mar?n S?nchez), Navarre (M.F. Slon Roblero, J. Manrique Escola, and J. Arteaga Coloma), and the Valencian region (REMRENAL) (M. Ferrer Alamar, N. Fuster Camarena, and J. P?rez Penad?s), Swedish Renal Registry (SNR) (K.G. Pr?tz, M. Stendahl, M. Evans, S. Sch?n, T. Lundgren, and M. Segelmark), Swiss Dialysis Registry (P. Amb?hl and R. Winzeler), Dutch Renal Registry (RENINE) (L. Heuveling, S. Vogelaar, and M. Hemmelder), Tunisia, Sfax region (F. Jarraya and D. Zalila), Registry of the Nephrology, Dialysis and Transplantation in Turkey (TSNNR) (G. S?leymanlar, N. Seyahi, and K. Ate?), Ukrainian Renal Data System (URDS) (M. Kolesnyk, S. Nikolaenko, and O. Razvazhaieva), UK Renal Registry (UKRR) (all the staff of the UKRR and of the renal units submitting data), and Scottish Renal Registry (SRR) (all of the Scottish renal units). ERA-EDTA Registry committee members. C. Zoccali, Italy (ERA-EDTA President), Z.A. Massy, France (Chairman), F.J. Caskey, United Kingdom, C. Couchoud, France, M. Evans, Sweden, P. Finne, Finland, J.W. Groothoff, the Netherlands, J. Harambat, France, J.G. Heaf, Denmark, F. Jarraya, Tunisia, M. Nordio, Italy, and I. Rychlik, Czech Republic., Service de Néphrologie [CHU Pitié-Salpêtrière], CHU Pitié-Salpêtrière [AP-HP], Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP), Medical Informatics, APH - Aging & Later Life, APH - Quality of Care, Graduate School, APH - Methodology, ACS - Pulmonary hypertension & thrombosis, APH - Global Health, and Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Sorbonne Université (SU)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)

Subjects
0301 basic medicine, medicine.medical_treatment, [SDV]Life Sciences [q-bio], 030232 urology & nephrology, Conservative Treatment, DISEASE, 0302 clinical medicine, Germany, Medicine and Health Sciences, Registries, Renal Insufficiency, Kidney transplantation, education.field_of_study, hemodialysis, Greece, RENAL REPLACEMENT THERAPY, 3. Good health, Europe, peritoneal dialysis, Italy, Nephrology, Hemodialysis, medicine.medical_specialty, Population, hemodialysis [Keywords], Peritoneal dialysis, 03 medical and health sciences, Renal Dialysis, Internal medicine, medicine, Humans, Renal replacement therapy, education, Dialysis, Edetic Acid, Portugal, business.industry, Home hemodialysis, CARE, medicine.disease, 3126 Surgery, anesthesiology, intensive care, radiology, Kidney Transplantation, Transplantation, 030104 developmental biology, Spain, Kidney Failure, Chronic, DONATION, business, Ireland, transplantation
Abstract

The aims of this study were to determine the frequency of dialysis and kidney transplantation and to estimate the regularity of comprehensive conservative management (CCM) for patients with kidney failure in Europe. This study uses data from the ERA-EDTA Registry. Additionally, our study included supplemental data from Armenia, Germany, Hungary, Ireland, Kosovo, Luxembourg, Malta, Moldova, Montenegro, Slovenia and additional data from Israel, Italy, Slovakia using other information sources. Through an online survey, responding nephrologists estimated the frequency of CCM (i.e. planned holistic care instead of kidney replacement therapy) in 33 countries. In 2016, the overall incidence of replacement therapy for kidney failure was 132 per million population (pmp), varying from 29 (Ukraine) to 251 pmp (Greece). On 31 December 2016, the overall prevalence of kidney replacement therapy was 985 pmp, ranging from 188 (Ukraine) to 1906 pmp (Portugal). The prevalence of peritoneal dialysis (114 pmp) and home hemodialysis (28 pmp) was highest in Cyprus and Denmark respectively. The kidney transplantation rate was nearly zero in some countries and highest in Spain (64 pmp). In 28 countries with five or more responding nephrologists, the median percentage of candidates for kidney replacement therapy who were offered CCM in 2018 varied between none (Slovakia and Slovenia) and 20% (Finland) whereas the median prevalence of CCM varied between none (Slovenia) and 15% (Hungary). Thus, the substantial differences across Europe in the frequency of kidney replacement therapy and CCM indicate the need for improvement in access to various treatment options for patients with kidney failure. European UnionEuropean Commission [PP-01-2016]; ERAEDTA This study was funded by the European Union (grant PP-01-2016) and ERAEDTA.

Published
2020

6. Survival of patients treated with extended-hours haemodialysis in Europe: an analysis of the ERA-EDTA Registry

Author

Eric Laruelle, Brigit C. van Jaarsveld, Kitty J Jager, Frederic Collart, Helena Rydell, Cécile Couchoud, Aleix Cases, Jamie P. Traynor, Thijs T. Jansz, Jaakko Helve, Mustafa Arici, Ziad A. Massy, Marlies Noordzij, Carmine Zoccali, Anneke Kramer, Bård Waldum-Grevbo, CHU Pontchaillou [Rennes], Agence de la biomédecine [Saint-Denis la Plaine], Centre de recherche en épidémiologie et santé des populations (CESP), Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Université Paris-Sud - Paris 11 (UP11)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)-Université de Versailles Saint-Quentin-en-Yvelines (UVSQ), Hôpital Ambroise Paré [AP-HP], European Renal Association-European Dialysis and Transplant Association, ERA-EDTA, We would like to thank the patients and the staff of the dialysis and transplant units for contributing the data via their national and regional renal registries. Furthermore, we gratefully acknowledge the following registries and persons for their contributions of data: Austrian Dialysis and Transplant Registry (R. Kramar), French-speaking Belgian Society of Nephrology (J.M. des Grottes), Finnish Registry for Kidney Diseases (P. Finne, A. Pylsy and P.H. Groop), France: The Epidemiology and Information Network in Nephrology (REIN) (M. Lassalle), Norwegian Renal Registry (T. Leivestad, A.V. Reisæter and A. Åsberg), Swedish Renal Registry (K.G. Prütz, M. Stendahl, M. Evans, S. Schön, T. Lundgren and M. Segelmark), Scottish Renal Registry (all of the Scottish renal units), and the regional registry of Catalonia (E. Arcos, J. Comas and J. Tort) and the other ERA-EDTA Registry Committee members not mentioned above for their advice in the analysis and the drafting of this article: P. Ambühl, J. De Meester, M. Evans, P. Finne, J. Harambat, L. Mercadal, M. Nordio, S.S. Sørensen and E. Vidal, and M. Pippias and V.S. Stel in the AMC Registry office for data collection and management. The ERA-EDTA Registry is funded by the ERA-EDTA. This article was written by T. Jansz, M. Noordzij, A. Kramer, E. Laruelle, C. Couchoud, F. Collart, A. Cases, M. Arici, J. Helve, B. Waldum-Grevbo, H. Rydell, J. Traynor, C. Zoccali, Z.A. Massy, K.J. Jager and B.C. van Jaarsveld on behalf of the ERA-EDTA Registry, which is an official body of the ERA-EDTA., HUS Abdominal Center, Department of Medicine, Nefrologian yksikkö, Medical Informatics, ACS - Pulmonary hypertension & thrombosis, APH - Aging & Later Life, APH - Quality of Care, APH - Global Health, APH - Methodology, Nephrology, ACS - Diabetes & metabolism, and Université de Versailles Saint-Quentin-en-Yvelines (UVSQ)-Université Paris-Sud - Paris 11 (UP11)-Assistance publique - Hôpitaux de Paris (AP-HP) (AP-HP)-Hôpital Paul Brousse-Institut National de la Santé et de la Recherche Médicale (INSERM)

Subjects
Male, medicine.medical_treatment, 030232 urology & nephrology, 030204 cardiovascular system & hematology, [SDV.MHEP.UN]Life Sciences [q-bio]/Human health and pathology/Urology and Nephrology, 0302 clinical medicine, Registries, nocturnal haemodialysis, Mortality rate, Hazard ratio, RENAL REPLACEMENT THERAPY, Middle Aged, Prognosis, DIALYSIS OUTCOMES, Hemodiàlisi, 3. Good health, Europe, Survival Rate, haemodialysis, Nephrology, Hemodialysis, ERA-EDTA Registry, Female, PRACTICE PATTERNS, INTENSIVE HEMODIALYSIS, medicine.medical_specialty, survival, 03 medical and health sciences, MORTALITY RISK, Renal Dialysis, LEFT-VENTRICULAR MASS, Internal medicine, medicine, Mortalitat, Humans, Renal replacement therapy, Mortality, Dialysis, Aged, Transplantation, HOME HEMODIALYSIS, CONVENTIONAL HEMODIALYSIS, business.industry, Proportional hazards model, Home hemodialysis, KIDNEY-DISEASE, Original Articles, 3126 Surgery, anesthesiology, intensive care, radiology, Confidence interval, Kidney Failure, Chronic, [SDV.SPEE]Life Sciences [q-bio]/Santé publique et épidémiologie, extended-hours, business, CENTER NOCTURNAL HEMODIALYSIS
Abstract

Background Previous US studies have indicated that haemodialysis with ≥6-h sessions [extended-hours haemodialysis (EHD)] may improve patient survival. However, patient characteristics and treatment practices vary between the USA and Europe. We therefore investigated the effect of EHD three times weekly on survival compared with conventional haemodialysis (CHD) among European patients. Methods We included patients who were treated with haemodialysis between 2010 and 2017 from eight countries providing data to the European Renal Association–European Dialysis and Transplant Association Registry. Haemodialysis session duration and frequency were recorded once every year or at every change of haemodialysis prescription and were categorized into three groups: CHD (three times weekly, 3.5–4 h/treatment), EHD (three times weekly, ≥6 h/treatment) or other. In the primary analyses we attributed death to the treatment at the time of death and in secondary analyses to EHD if ever initiated. We compared mortality risk for EHD to CHD with causal inference from marginal structural models, using Cox proportional hazards models weighted for the inverse probability of treatment and censoring and adjusted for potential confounders. Results From a total of 142 460 patients, 1338 patients were ever treated with EHD (three times, 7.1 ± 0.8 h/week) and 89 819 patients were treated exclusively with CHD (three times, 3.9 ± 0.2 h/week). Crude mortality rates were 6.0 and 13.5/100 person-years. In the primary analyses, patients treated with EHD had an adjusted hazard ratio (HR) of 0.73 [95% confidence interval (CI) 0.62–0.85] compared with patients treated with CHD. When we attributed all deaths to EHD after initiation, the HR for EHD was comparable to the primary analyses [HR 0.80 (95% CI 0.71–0.90)]. Conclusions EHD is associated with better survival in European patients treated with haemodialysis three times weekly.

Published
2019

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