title: Indication for Dialysis Initiation and Mortality in Patients With Chronic Kidney Failure: A Retrospective Cohort Study.
abstract: BACKGROUND
  Initiation of maintenance dialysis therapy for patients with chronic kidney failure is a period of high risk for adverse patient outcomes. Whether indications for dialysis therapy initiation are associated with mortality in this population is unknown.
  
  
  METHODS
  Retrospective cohort study.
  
  
  METHODS
  461 patients who initiated dialysis therapy (hemodialysis, 437; peritoneal dialysis, 24) from January 1, 2004, through December 31, 2012, and were treated in facilities operated by a single dialysis organization. Follow-up for the primary outcome was through December 31, 2013.
  
  
  METHODS
  Clinically documented primary indication for dialysis therapy initiation, as categorized into 4 groups: laboratory evidence of kidney function decline (reference category), uremic symptoms, volume overload or hypertension, and other/unknown.
  
  
  RESULTS
  All-cause mortality.
  
  
  RESULTS
  During a median follow-up of 2.4 years, 183 (40%) patients died. Crude mortality rates were 10.0 (95% CI, 6.8-14.7), 12.7 (95% CI, 10.2-15.7), 21.7 (95% CI, 16.4-28.6), and 12.2 (95% CI, 6.8-14.7) deaths/100 patient-years among patients initiating dialysis therapy primarily for laboratory evidence of kidney function decline, uremic symptoms, volume overload or hypertension, and other/unknown reason, respectively. Following adjustment for demographic variables, coexisting illnesses, and estimated glomerular filtration rate, initiation of dialysis therapy for uremic symptoms, volume overload or hypertension, or other/unknown reasons was associated with 1.12 (95% CI, 0.72-1.77), 1.69 (95% CI, 1.02-2.80), and 1.28 (95% CI, 0.73-2.26) times higher risk, respectively, for subsequent mortality compared to initiation for laboratory evidence of kidney function decline.
  
  
  CONCLUSIONS
  Possibility of residual confounding by unmeasured variables; reliance on clinical documentation to ascertain exposure.
  
  
  CONCLUSIONS
  Patients initiating dialysis therapy due to volume overload may have increased risk for mortality compared with patients initiating dialysis due to laboratory evidence of kidney function decline. Further studies are needed to identify and test interventions that might reduce this risk.
authors.affiliation: Kidney Research Institute, Seattle, WA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA. Electronic address: mbr@uw.edu.
authors.forename: Matthew B
authors.initials: MB
authors.lastname: Rivara
authors.affiliation: Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Chang Huei
authors.initials: CH
authors.lastname: Chen
authors.affiliation: Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Anupama
authors.initials: A
authors.lastname: Nair
authors.affiliation: Northwest Kidney Centers, Seattle, WA.
authors.forename: Denise
authors.initials: D
authors.lastname: Cobb
authors.affiliation: Kidney Research Institute, Seattle, WA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Jonathan
authors.initials: J
authors.lastname: Himmelfarb
authors.affiliation: Kidney Research Institute, Seattle, WA; Division of Nephrology, Department of Medicine, University of Washington, Seattle, WA.
authors.forename: Rajnish
authors.initials: R
authors.lastname: Mehrotra
mesh_terms: D015331:Cohort Studies; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis; D012189:Retrospective Studies
keywords: End-stage renal disease (ESRD); all-cause mortality; chronic kidney failure; clinical decision making; dialysis initiation; hemodialysis; hypertension; incident ESRD; indications for renal replacement therapy; peritoneal dialysis; symptoms; uremic symptoms; volume overload