title: Confounding factors for early death in incident end-stage renal disease patients: Role of emergency dialysis start.
abstract: Hemodialysis (HD) has been associated with higher 1-year mortality than peritoneal dialysis (PD) after dialysis start. Confounding effects of late referral, emergency dialysis start, or start with central venous catheter on this association have never been studied concomitantly. Survival was studied among the 495 incident dialysed patients in our department from 1995 to 2006 and followed at least 1 year until December 31, 2007. Nested Cox models adjusted on patient characteristics explored factors associated with 1-year and ≥1-year mortality. Hemodialysis patients were 332 (67.1%), 104 (21.0%) were late referred (<6 months), 167 (33.7%) started dialysis in emergency, and 144 (29.1%) started with central venous catheter. When adjusted only on age, sex, and comorbidities, HD was associated with poor 1-year outcome: adjusted hazard ratio (aHR) for death in HD vs. PD was 1.77, P=0.02. In fully adjusted model, among first dialysis feature variables, only emergency dialysis start was significantly associated with 1-year mortality: aHR 1.53, P=0.02. Dialysis modality was not associated with 1-year mortality rates in this fully adjusted model: aHR in HD vs. PD became 1.03, P=0.91. In ≥1-year period, HD was associated with lower mortality than PD (aHR 0.61, P=0.004), whereas other first dialysis features were not associated with death. Other factors associated with death were age, type 2 diabetes, peripheral vascular disease, heart failure, and hepatic failure. Negative association between HD and 1-year survival on dialysis was explained by confounders. Emergency dialysis start was strongly associated with early mortality on dialysis. Its prevention may improve patient survival.
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Chrystèle
authors.initials: C
authors.lastname: Descamps
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Michel
authors.initials: M
authors.lastname: Labeeuw
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Pierre
authors.initials: P
authors.lastname: Trolliet
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Rémi
authors.initials: R
authors.lastname: Cahen
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: René
authors.initials: R
authors.lastname: Ecochard
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Claire
authors.initials: C
authors.lastname: Pouteil-Noble
authors.affiliation: Hospices Civils de Lyon, Department of Nephrology and Renal Transplantation, Lyon Sud Hospital, Pierre-Benite, FranceUniversité de Lyon 1, Villeurbanne, FranceHospices Civils de Lyon, Department of Biostatistic, Lyon, FranceUniversité de Lyon 1, UMR CNRS 5558, Lyon, France.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Villar
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D010530:Peritoneal Dialysis / Q000379:methods* / Q000401:mortality; D011446:Prospective Studies; D006435:Renal Dialysis / Q000379:methods* / Q000401:mortality