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

Masaki Okazaki, Daijo Inaguma, Takahiro Imaizumi, Akiko Kada, Takaaki Yaomura, Naotake Tsuboi, Shoichi Maruyama

Research output: Contribution to journalArticle

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.

Original languageEnglish
Article number65
JournalBMC Nephrology
Volume19
Issue number1
DOIs
Publication statusPublished - 14-03-2018

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Dialysis
Japan
Cohort Studies
Referral and Consultation
Prospective Studies
Mortality
Confidence Intervals
Proportional Hazards Models
Cardiovascular Diseases
Nephrologists
Information Services
Renal Insufficiency
Cause of Death

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Okazaki, Masaki ; Inaguma, Daijo ; Imaizumi, Takahiro ; Kada, Akiko ; Yaomura, Takaaki ; Tsuboi, Naotake ; Maruyama, Shoichi. / 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. In: BMC Nephrology. 2018 ; Vol. 19, No. 1.
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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.",
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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. / Okazaki, Masaki; Inaguma, Daijo; Imaizumi, Takahiro; Kada, Akiko; Yaomura, Takaaki; Tsuboi, Naotake; Maruyama, Shoichi.

In: BMC Nephrology, Vol. 19, No. 1, 65, 14.03.2018.

Research output: Contribution to journalArticle

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T1 - Unfavorable effects of history of volume overload and late referral to a nephrologist on mortality in patients initiating dialysis

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AU - Okazaki, Masaki

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AU - Imaizumi, Takahiro

AU - Kada, Akiko

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AU - Tsuboi, Naotake

AU - Maruyama, Shoichi

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AB - 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.

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