title: Impact of weaning from acute dialytic therapy on outcomes of chronic kidney disease following urgent-start dialysis.
abstract: Discontinuation of acute, unplanned dialysis is always an important therapeutic goal in dialysis-requiring patients with existing chronic kidney disease. Only a limited proportion of patients could be weaned off dialysis and remained dialysis-free. Here we performed a multicenter, observational study to investigate factors associated with successful weaning from acute dialysis, and to explore the potential impact of weaning itself on outcomes of patients with chronic kidney disease following urgent-start dialysis. We recruited 440 chronic kidney disease patients with a baseline estimated glomerular filtration rate <45 ml/min per 1/73 m2, and used propensity score-adjusted Cox regression analysis to measure the effect of weaning from acute dialysis on death during the index hospitalization and death or readmission after discharge. Over 2 years, 64 of 421 (15.2%) patients who survived >1 month died, and 36 (8.6%) were removed from dialysis, with 26 (6.2%) remaining alive and dialysis-free. Logistic regression analysis found that age ≧ 65 years, ischemic acute tubular necrosis, nephrotoxic exposure, urinary obstruction, and higher predialysis estimated glomerular filtration rate and serum hemoglobin were predictors of weaning off dialysis. After adjustment for propensity scores for dialysis weaning, Cox proportional hazards models showed successful weaning from dialysis (adjusted hazard ratio 0.06; 95% confidence interval 0.01 to 0.35), along with a history of hypertension and serum albumin, were independent protectors for early death. Conversely, a history of stroke, peripheral arterial disease and cancer predicted the occurrence of early mortality. In conclusion, this prospective cohort study shows that compared to patients with chronic kidney disease who became end-stage renal disease after acute dialysis, patients who could be weaned off acute dialytic therapy were associated with reduced risk of premature death over a 2-year observation period.
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan; Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Yung-Ming
authors: YM
authors: Chen
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, Yun-Lin Branch, Yun-Lin, Taiwan.
authors: Wen-Yi
authors: WY
authors: Li
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Vin-Cent
authors: VC
authors: Wu
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Yi-Cheng
authors: YC
authors: Wang
authors: Division of Nephrology, Department of Internal Medicine, Kaohsiung Medical University Hospital; Faculty of Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan; Adjunctive Investigator, Division of Geriatrics and Gerontology, Institute of Population Health Sciences, National Health Research Institutes, Taiwan.
authors: Shang-Jyh
authors: SJ
authors: Hwang
authors: Division of Nephrology, Department of Internal Medicine, Tri-Service General Hospital, National Defense Medical Center, Taipei, Taiwan.
authors: Shih-Hwa
authors: SH
authors: Lin
authors: Renal Division, Department of Internal Medicine, National Taiwan University Hospital, College of Medicine, National Taiwan University, Taipei, Taiwan.
authors: Kwan-Dun
authors: KD
authors: Wu
mesh_terms: D000328:Adult; D000368:Aged; D000553:Ambulatory Care; D015331:Cohort Studies; D003324:Coronary Artery Disease / Q000209:etiology / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D005260:Female; D005919:Glomerular Filtration Rate; D006454:Hemoglobins / Q000378:metabolism; D006801:Humans; D006973:Hypertension / Q000097:blood / Q000209:etiology / Q000473:pathology / Q000628:therapy*; D007668:Kidney / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009026:Mortality; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000150:complications / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D012307:Risk Factors; D012709:Serum Albumin
chemical_list: D006454:Hemoglobins; D012709:Serum Albumin