title: Initial glomerular filtration rate and survival in hemodialysis. The role of permanent vascular access.
abstract: BACKGROUND
  A significant increase in the number of patients starting chronic hemodialysis (HD) with an estimated glomerular filtration rate (eGFR)≥10 mL/min/1.73 m(2) was observed in Argentina between 2004 and 2009.
  
  
  METHODS
  In order to study this topic, we calculated the mortality hazard ratios (HR) in a cohort of incident HD individuals from the Argentine Registry of Chronic Dialysis [Registro Argentino de Diálisis Crónica] (2004-2009), grouped according to the initial eGFR (0-4.9, 5-9.9, 10-14.9 and ≥15 mL/min/1.73 m(2) ; reference group 0-4.9) estimated by CKD-EPI; in three cohorts: "total population", "healthy" (<65 years, without diabetes or comorbidities) and "planned entry" (with permanent vascular access).
  
  
  RESULTS
  After adjusting the population (n=16,931) for age, gender, coexisting conditions, serum albumin, income, and temporary vascular access a HR of 1.19 (95%CI:1.07-1.33) was observed in the group with eGFR≥15 mL/min/1.73 m(2). In the cohort of 3,897 "healthy" after adjusting for the same co-variates, HRs of 1.44 (95%CI: 1.08-1.65) and 1.65 (95%CI: 1.06-2.55) were obtained for the groups with baseline eGFR values of 10-14.9 and ≥15 mL/min/1.73 m(2), respectively. In "planned entry" patients (n=6,280), after adjusting for age, gender, co-morbidities, serum albumin and income, HRs in all groups were not significantly different as compared to the control group.
  
  
  CONCLUSIONS
  HD initiation with eGFR>10 mL/min/1.73 m(2) shows no survival advantage. The higher mortality in the group with >eGFR starting dialysis looks like an "artifact" related to higher age, more co-morbidities, low albuminemia and the use of temporary vascular access.
authors.forename: Sergio
authors.initials: S
authors.lastname: Marinovich
authors.forename: Jaime
authors.initials: J
authors.lastname: Pérez-Loredo
authors.forename: Carlos
authors.initials: C
authors.lastname: Lavorato
authors.forename: Guillermo
authors.initials: G
authors.lastname: Rosa-Díez
authors.forename: Liliana
authors.initials: L
authors.lastname: Bisigniano
authors.forename: Víctor
authors.initials: V
authors.lastname: Fernández
authors.forename: Daniela
authors.initials: D
authors.lastname: Hansen-Krogh
mesh_terms: D002408:Catheters, Indwelling; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000503:physiopathology* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate; D062666:Vascular Access Devices