SO062TRENDS OF BASELINE-RISK OF MORTALITY AND OBSERVED 3-YEAR MORTALITY IN INCIDENT DIALYSIS PATIENTS IN GERMANY

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Martin Wagner ◽  
Katherine Rascher ◽  
Heyke Cramer ◽  
Mathias Schaller ◽  
Rolf Dieter Bach ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Patient Characteristics ◽  
Baseline Risk ◽  
Dialysis Patients ◽  
Cox Models ◽  
Non Profit ◽  
C Statistic ◽  
Risk Of Mortality ◽  
Baseline Mortality ◽  
End Stage

Abstract Background and Aims The risk of mortality varies considerably among end stage kidney disease patients. As the population ages, patients on renal replacement therapy are presenting with an increasing number of non-renal complications such as heart failure and, subsequently, an increased mortality risk. Thus, in recent years, patient care in dialysis units has become more complex. In this study we describe trends in baseline risk of mortality and 3-year mortality risk in a sample of incident dialysis patients in Germany. Method The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning hemodialysis (HD) or peritoneal dialysis (PD) treatment between 2008 and 2014 who were enrolled in QiN within 6 months after inception of dialysis. Primary outcome was all-cause death within 3 years. Cox models were censored for transplantation and loss to follow-up. Baseline risk of mortality was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. In this score higher values indicate greater mortality risk. Results A total of n=20369 patients were analyzed, HD n=18255 (89.6%), PD n=2114 (10.4%). Baseline mortality risk increased over time: AROii score for the 2008/09 incidence cohort was median 8.1 (interquartile range 4.4; 11.9), for the 2010/11 cohort 8.8 (5.0; 12.0) and for the 2012-14 cohort 9.0 (5.0; 12.0), p<0.001. The AROii score was highly predictive for observed 3-year mortality (Hazard Ratio [HR] 1.196 [1.190; 1.203], p<0.001; C-statistic 0.736). In spite of higher baseline mortality risk in patients starting dialysis in more recent years, mortality was lower as compared to the earlier cohorts (HR 0.976 [0.964; 0.988), p<0.001). The results were mainly driven by HD patients. In PD patients baseline mortality risk increased, but no trend on mortality was observed. Conclusion Our results show that patients starting dialysis in Germany have become sicker over the last decade, as indicated by the AROii risk score. Simultaneously the observed risk of mortality decreased in recent years, indicating success of optimized medical treatment including dialysis therapy as well as non-nephrology medical care.

MO930BURDEN OF DISEASE IN INCIDENT DIALYSIS PATIENTS WAIT LISTED FOR KIDNEY TRANSPLANTATION 2008 – 2016 IN GERMANY

2021 ◽  
Vol 36 (Supplement_1) ◽  
Author(s):  
Martin Wagner ◽  
Wolfgang Arns ◽  
Katherine Rascher ◽  
Heyke Cramer ◽  
Mathias Schaller ◽  
...  
Keyword(s):  
Kidney Transplantation ◽  
Mortality Risk ◽  
Burden Of Disease ◽  
Waiting Times ◽  
Patient Characteristics ◽  
Waiting List ◽  
Dialysis Patients ◽  
Non Profit ◽  
Laboratory Variables ◽  
Over Time

Abstract Background and Aims Only a subset of all patients on dialysis is eligible for kidney transplantation (KTx) due to the large variation of mortality risk. It has been shown that the burden of disease is increasing over the last years in patients at dialysis inception. Moreover, the number of available kidney grafts is decreasing, resulting in a prolonged time on the waiting list. In our study we describe the burden of disease and 3-year mortality in a sample of incident dialysis patients in Germany, stratified by KTx status, including trends over time. Method The QiN (Quality in Nephrology) dataset is a registry-based observational study in which >90% of all patients treated in dialysis centers of the non-profit kidney care provider KfH are enrolled. In our analyses we included all adult patients beginning dialysis treatment between 2008 and 2016. Primary outcome was 3-year all-cause death up until Dec 31, 2019. Patients were stratified by last available KTx- status: (a) KTx within 3 years, (b) on dialysis - on waiting list, (c) on dialysis - in evaluation for KTx, (d) on dialysis - KTx never planned, (e) on dialysis - KTx status missing. The burden of disease was assessed by the AROii score (Floege et al. 2015), a predictive model including patient characteristics, laboratory variables and dialysis parameters. Results Of a total of n=25987 incident patients analyzed, 3.2% underwent KTx within 3 years, 10.6% were listed for KTx, and 13.4% were in evaluation. In 49.5% KTx was never planned and in 23.3% KTx status was missing. These groups differed significantly in median AROii score, reflecting their burden of disease at dialysis inception: KTx never planned or missing (AROii score 10) as compared to KTx (AROii score 1), listed (AROii score 3) and in evaluation (AROii score 4) (p<0.001). Similarly, 3-year observed mortality (n=8059 [31%]) differed widely across KTx strata (log rank p<0.001), ranging from 11% in listed patients to 44% (HR 5,982; [5.335; 6.707]) in those with missing KTx status (figure). In the period 2008-2019 the number of KTx within 3 years decreased, but the proportion of patients on the waiting list and the proportion of patients in evaluation increased. In all patients on dialysis the burden of disease at dialysis inception increased over time across KTx strata (p<0.05). Conclusion About three quarters of patients started dialysis with a very high mortality risk and at least half of them were considered ineligible for KTx. Patients listed or in evaluation for KTx in Germany have become sicker over the last decade. With decreasing numbers of KTx in Germany the time on the waiting list is prolonged. Longer waiting times and the increasing burden of disease result in advanced risk at the time of transplantation.

scholarly journals Mortality after amputation in dialysis patients is high but not modified by diabetes status

2019 ◽  
Vol 13 (6) ◽  
pp. 1077-1082 ◽  
Author(s):  
Marielle A Schroijen ◽  
Merel van Diepen ◽  
Jaap F Hamming ◽  
Friedo W Dekker ◽  
Olaf M Dekkers
Keyword(s):  
Mortality Risk ◽  
Interaction Analysis ◽  
Diabetic Patients ◽  
Comorbid Conditions ◽  
Dialysis Patients ◽  
Diabetes Status ◽  
Patients With Diabetes ◽  
Stage Renal Disease ◽  
End Stage ◽  
Incident Cases

Abstract Background Survival among dialysis patients with diabetes mellitus (DM) is inferior to survival of non-diabetic dialysis patients, probably due to the higher prevalence of diabetes-related comorbid conditions. One could hypothesize that these comorbid conditions also contribute to a decreased survival after amputation in diabetic patients compared with non-diabetic patients on dialysis. Methods Data were collected from the Netherlands Cooperative Study on the Adequacy of Dialysis, a multicentre, prospective cohort study in which new patients with end-stage renal disease were monitored until transplantation or death. Amputation rates (incident cases) were calculated in patients with and without DM. The primary endpoint was all-cause survival after first amputation during dialysis therapy in diabetic patients compared with non-diabetic dialysis patients with an amputation. This was formally assessed using interaction analysis (Poisson regression). Results During follow-up (mean duration 2.9 years), 50 of the 413 diabetic patients had a new amputation (12.1%), compared with 20 of 1553 non-diabetic patients (1.2%). Amputation rates/1000 person-years were 47.9 [95% confidence interval (CI) 36.3–63.2] and 4.1 (95% CI 2.7–6.4), respectively, for diabetic patients and non-diabetic patients. Amputation increased mortality risk more than 4-fold in patients without diabetes [hazard ratio (HR) 4.6 (95% CI 2.8–7.6)] as well as in patients with diabetes [HR 4.6 (95% CI 3.3–6.4)]. No formal interaction between diabetes and amputation was found (P = 0.12). Conclusions Amputation in dialysis patients is associated with a 4-fold increased mortality risk; this mortality risk was similar for diabetes and non-diabetes patients. Importantly, the risk for amputation is 10-fold higher in DM compared with non-diabetic dialysis patients.

scholarly journals Unraveling the Association Between Gait and Mortality—One Step at a Time

2019 ◽  
Vol 75 (6) ◽  
pp. 1184-1190 ◽  
Author(s):  
Lisanne J Dommershuijsen ◽  
Berna M Isik ◽  
Sirwan K L Darweesh ◽  
Jos N van der Geest ◽  
M Kamran Ikram ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Gait Speed ◽  
Causes Of Death ◽  
Health Indicators ◽  
Cox Models ◽  
Risk Of Mortality ◽  
Increased Risk ◽  
Specific Mortality ◽  
One Step ◽  
Base Of Support

Abstract Background Slowness of walking is one of the very first signs of aging and is considered a marker for overall health that is strongly associated with mortality risk. In this study, we sought to disentangle the clinical drivers of the association between gait and mortality. Methods We included 4,490 participants of the Rotterdam Study who underwent a gait assessment between 2009 and 2015 and were followed-up for mortality until 2018. Gait was assessed with an electronic walkway and summarized into the domains Rhythm, Phases, Variability, Pace, Tandem, Turning, and Base of Support. Cox models adjusted for age, sex, and height were built and consecutively adjusted for six categories of health indicators (lifestyle, musculoskeletal, cardiovascular, pulmonary, metabolic, and neurological). Analyses were repeated in comorbidity-free individuals. Results Multiple gait domains were associated with an increased risk of mortality, including Pace (hazard ratio (HR) per SD worse gait, adjusted for other domains: 1.34 [1.19–1.50]), Rhythm (HR: 1.12 [1.02–1.23]) and Phases (HR: 1.12 [1.03–1.21]). Similarly, a 0.1 m/s decrease in gait speed was associated with a 1.21 (1.15–1.27) times higher hazard of mortality (HR fully adjusted: 1.14 [1.08–1.20]). In a comorbidity-free subsample, the HR per 0.1 m/s decrease in gait speed was 1.25 (1.09–1.44). Cause-specific mortality analyses revealed an association between gait speed and multiple causes of death. Conclusions Several gait domains were associated with mortality risk, including Pace which primarily represents gait speed. The association between gait speed and mortality persisted after an extensive adjustment for covariates, suggesting that gait is a marker for overall health.

scholarly journals Association of BMI, comorbidities and all-cause mortality by using a baseline mortality risk model

PLoS ONE ◽  
2021 ◽  
Vol 16 (7) ◽  
pp. e0253696
Author(s):  
Jia Li ◽  
Gyorgy Simon ◽  
M. Regina Castro ◽  
Vipin Kumar ◽  
Michael S. Steinbach ◽  
...  
Keyword(s):  
Body Mass ◽  
Mortality Risk ◽  
Risk Model ◽  
Risk Groups ◽  
Baseline Risk ◽  
Increased Risk ◽  
Wide Range ◽  
Baseline Mortality ◽  
All Cause Mortality

Objective The association of body mass index (BMI) and all-cause mortality is controversial, frequently referred to as a paradox. Whether the cause is metabolic factors or statistical biases is still controversial. We assessed the association of BMI and all-cause mortality considering a wide range of comorbidities and baseline mortality risk. Methods Retrospective cohort study of Olmsted County residents with at least one BMI measurement between 2000–2005, clinical data in the electronic health record and minimum 8 year follow-up or death within this time. The cohort was categorized based on baseline mortality risk: Low, Medium, Medium-high, High and Very-high. All-cause mortality was assessed for BMI intervals of 5 and 0.5 Kg/m2. Results Of 39,739 subjects (average age 52.6, range 18–89; 38.1% male) 11.86% died during 8-year follow-up. The 8-year all-cause mortality risk had a “U” shape with a flat nadir in all the risk groups. Extreme BMI showed higher risk (BMI <15 = 36.4%, 15 to <20 = 15.4% and ≥45 = 13.7%), while intermediate BMI categories showed a plateau between 10.6 and 12.5%. The increased risk attributed to baseline risk and comorbidities was more obvious than the risk based on BMI increase within the same risk groups. Conclusions There is a complex association between BMI and all-cause mortality when evaluated including comorbidities and baseline mortality risk. In general, comorbidities are better predictors of mortality risk except at extreme BMIs. In patients with no or few comorbidities, BMI seems to better define mortality risk. Aggressive management of comorbidities may provide better survival outcome for patients with body mass between normal and moderate obesity.

scholarly journals Decreased mortality and increased side effects in COVID-19 patients treated with IL-6 receptor antagonists: systematic review and meta-analysis

2021 ◽  
Vol 11 (1) ◽  
Author(s):  
Jishnu Malgie ◽  
Jan W. Schoones ◽  
Maurice P. Zeegers ◽  
Bart G. Pijls
Keyword(s):  
Systematic Review ◽  
Side Effects ◽  
Mortality Risk ◽  
Meta Analysis ◽  
Standard Of Care ◽  
Baseline Risk ◽  
Cochrane Library ◽  
Receptor Antagonists ◽  
Impaired Liver Function ◽  
Baseline Mortality

AbstractThere is controversy whether IL-6 (receptor) antagonists are beneficial in treating COVID-19 patients. We therefore update our systematic review to answer the following research questions: (1) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have lower mortality compared to standard of care? (2) Do patients hospitalized for COVID-19 treated with IL-6 (receptor) antagonists have more side effects compared to standard of care? The following databases were search up to December 1st 2020: PubMed, PMC PubMed Central, MEDLINE, WHO COVID-19 Database, Embase, Web-of-Science, COCHRANE LIBRARY, Emcare and Academic Search Premier. In order to pool the risk ratio (RR) and risk difference of individual studies we used random effects meta-analysis. The search strategy retrieved 2975 unique titles of which 71 studies (9 RCTs and 62 observational) studies comprising 29,495 patients were included. Mortality (RR 0.75) and mechanical ventilation (RR 0.78) were lower and the risk of neutropenia (RR 7.3), impaired liver function (RR 1.67) and secondary infections (RR 1.26) were higher for patients treated with IL-6 (receptor) antagonists compared to patients not treated with treated with IL-6 (receptor) antagonists. Our results showed that IL-6 (receptor) antagonists are effective in reducing mortality in COVID-19 patients, while the risk of side effects was higher. The baseline risk of mortality was an important effect modifier: IL-6 (receptor) antagonists were effective when the baseline mortality risk was high (e.g. ICU setting), while they could be harmful when the baseline mortality risk was low.

scholarly journals Validation of prognostic indices for short term mortality in an incident dialysis population of older adults >75

PLoS ONE ◽  
2021 ◽  
Vol 16 (1) ◽  
pp. e0244081
Author(s):  
Bjorg Thorsteinsdottir ◽  
LaTonya J. Hickson ◽  
Rachel Giblon ◽  
Atieh Pajouhi ◽  
Natalie Connell ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Small Sample Size ◽  
Characteristic Curve ◽  
Small Sample ◽  
Dialysis Patients ◽  
Short Term ◽  
Homogeneous Population ◽  
Predictive Values ◽  
C Statistic ◽  
Prognostic Indices

Rational and objective Prognosis provides critical knowledge for shared decision making between patients and clinicians. While several prognostic indices for mortality in dialysis patients have been developed, their performance among elderly patients initiating dialysis is unknown, despite great need for reliable prognostication in that context. To assess the performance of 6 previously validated prognostic indices to predict 3 and/or 6 months mortality in a cohort of elderly incident dialysis patients. Study design Validation study of prognostic indices using retrospective cohort data. Indices were compared using the concordance (“c”)-statistic, i.e. area under the receiver operating characteristic curve (ROC). Calibration, sensitivity, specificity, positive and negative predictive values were also calculated. Setting & participants Incident elderly (age ≥75 years; n = 349) dialysis patients at a tertiary referral center. Established predictors Variables for six validated prognostic indices for short term (3 and 6 month) mortality prediction (Foley, NCI, REIN, updated REIN, Thamer, and Wick) were extracted from the electronic medical record. The indices were individually applied as per each index specifications to predict 3- and/or 6-month mortality. Results In our cohort of 349 patients, mean age was 81.5±4.4 years, 66% were male, and median survival was 351 days. The c-statistic for the risk prediction indices ranged from 0.57 to 0.73. Wick ROC 0.73 (0.68, 0.78) and Foley 0.67 (0.61, 0.73) indices performed best. The Foley index was weakly calibrated with poor overall model fit (p <0.01) and overestimated mortality risk, while the Wick index was relatively well-calibrated but underestimated mortality risk. Limitations Small sample size, use of secondary data, need for imputation, homogeneous population. Conclusion Most predictive indices for mortality performed moderately in our incident dialysis population. The Wick and Foley indices were the best performing, but had issues with under and over calibration. More accurate indices for predicting survival in older patients with kidney failure are needed.

scholarly journals Survival and predictive factors in dialysis patients with COVID-19 in Japan: a nationwide cohort study

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Kan Kikuchi ◽  
Masaomi Nangaku ◽  
Munekazu Ryuzaki ◽  
Tomoyuki Yamakawa ◽  
Oota Yoshihiro ◽  
...  
Keyword(s):  
Overall Survival ◽  
Multivariate Analysis ◽  
Predictive Factors ◽  
Mortality Risk ◽  
Japanese Society ◽  
Task Force ◽  
Rank Test ◽  
Dialysis Patients ◽  
Risk Of Mortality ◽  
Increased Risk

Abstract Background The Japanese Association of Dialysis Physicians, the Japanese Society for Dialysis Therapy, and the Japanese Society of Nephrology jointly established COVID-19 Task Force Committee and began surveying the number of newly infected patients. Methods This registry of the COVID-19 Task Force Committee was used to collect data of dialysis patients; a total of 1010 dialysis patients with COVID-19 were included in the analysis. Overall survival of patients was investigated with stratification by age group, complication status, and treatment. In addition, predictive factors for mortality were also investigated. The overall survival was estimated by Kaplan–Meier methods and compared by using log-rank test. Multivariate analysis was performed to identify the risk factor of mortality. For all statistical analyses, p < 0.05 was considered to be statistically significant. Results The mortality risk was increased with age (p < 0.001). The mortality risk was significantly higher in patients with peripheral arterial disease (HR: 1.49, 95% CI 1.05–2.10) and significantly lower in patients who were treated with remdesivir (HR: 0.60, 95% CI 0.37–0.98). Multivariate analysis showed increased risk of mortality with increment in BMI, and increment in CRP, and decreased risk with increment in albumin. Conclusion Dialysis patients have a high severity of illness and a high risk of mortality in cases of COVID-19. Treatment with remdesivir might be effective in shortening the duration of hospitalization and reducing the risk of mortality.

scholarly journals P1159MILD BLOOD PRESSURE VARIABILITY IS ASSOCIATED WITH BETTER SURVIVAL IN PATIENTS WITH END STAGE RENAL DISEASE AND PERITONEAL DIALYSIS

2020 ◽  
Vol 35 (Supplement_3) ◽  
Author(s):  
Hanri Afghahi ◽  
Salmir Nasic ◽  
Khaled Alhomsi ◽  
Henrik Hadimeri ◽  
Helena Rydell ◽  
...  
Keyword(s):  
Blood Pressure ◽  
Peritoneal Dialysis ◽  
Renal Disease ◽  
Mortality Risk ◽  
End Stage Renal Disease ◽  
Laboratory Findings ◽  
Risk Of Mortality ◽  
The Mean ◽  
Stage Renal Disease ◽  
End Stage

Abstract Background and Aims Recently, variability in blood pressure (BP) has been recognized as a risk factor for mortality and cardiovascular events in the general population. However, most studies included patients with normal or near normal kidney function. Aim To study the association between BP variability and the risk of all-cause mortality in patients with end stage renal disease (ESRD) and peritoneal dialysis (PD) treatment. Method From 2008 until the end of 2017, 2329 patients with ESRD and at least three months of PD (mean age: 63.8 years, men: 67.5%) were followed for 16 months in median (interquartile range: 11-28 months). Data were extracted from the Swedish Renal Register (SNR). The coefficient variation (CV = the ratio of the standard deviation (SD) to the mean value) was defined as BP variability in terms of systolic blood pressure (SBP), diastolic blood pressure (DBP), and mean arterial pressure (MAP) [SBP(SD)/SBP(mean), DBP(SD)/ DBP(mean), and MAP(SD)/MAP(mean), respectively]. The relationships between BP variability and mortality were examined by time-dependent Cox models to estimate hazard ratios (HR) and 95% confidence intervals (CI) in univariate and multivariate analyses, with adjustment for demographics, laboratory findings and comorbidity. Results During the follow-up period, 1054 (45%) deaths occurred. The mean level of BP variability was CV=0.10± 0.1. The highest rate of mortality was observed in the patients with the highest variability in SBP (CV&gt;0.25; 64% of those patients died). In the multivariate model, for each of the BP variables, we compared the risk of mortality in the lowest variability group (CV≤ 0.05) with that in the CV=0.10-0.15 group (reference): SBP: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); DBP: (HR 1.91, 95% CI 1.59- 2.23; p&lt;0.001); and MAP: (HR 1.73, 95% CI 1.44- 2.06; p&lt;0.001). Thus, for all BP variables, the lowest variability was associated with increased mortality risk. We then compared the highest variability group (CV&gt;0.25) with the CV=0.10-0.15 group (reference): SBP: (HR 1.60, 95% CI 1.14- 2.25; p&lt;0.001); DPB: (HR 1.74, 95% CI 1.44- 2.09; p&lt;0.001); and MAP: (HR 1.98, 95% CI 1.21- 3.27; p&lt;0.001). Thus, for all BP variables, the highest variability was related to increased mortality risk. Conclusion In this study, the association between BP variability and the risk of mortality was U-shaped in patients with ESRD and PD. Thus, both very low and high levels of BP variability were related to higher risk of mortality. Mild BP variability was associated with the lowest risk of mortality, which could suggest that, non-intensive and long duration of ultrafiltration (UF) with PD was probably beneficial in terms of survival

scholarly journals Warfarin Use and Increased Mortality in End-Stage Renal Disease

2017 ◽  
Vol 46 (4) ◽  
pp. 249-256 ◽  
Author(s):  
Mark C. Lin ◽  
Elani Streja ◽  
Melissa Soohoo ◽  
Medhat Hanna ◽  
Javad Savoj ◽  
...  
Keyword(s):  
Myocardial Infarction ◽  
Regression Analysis ◽  
Mortality Risk ◽  
End Stage Renal Disease ◽  
Warfarin Therapy ◽  
Dialysis Patients ◽  
Warfarin Treatment ◽  
Stage Renal Disease ◽  
End Stage ◽  
Esrd Patients

Background: Controversy exists regarding the benefits and risks of warfarin therapy in chronic kidney disease (CKD) and end-stage renal disease (ESRD) patients. In this study, we assessed mortality and cardiovascular outcomes associated with warfarin treatment in patients with stages 3-5 CKD and ESRD admitted to the University of California-Irvine Medical Center. Methods: In a retrospective matched cohort study, we identified 59 adult patients with stages 3-6 CKD initiated on warfarin during the period 2011-2013, and 144 patients with stages 3-6 CKD who had indications for anticoagulation therapy but were not initiated on warfarin. All-cause mortality risk associated with warfarin treatment was estimated using Cox proportional hazard regression analysis, and the risk of significant bleeding and major adverse cardiovascular events were analyzed with Poisson regression analysis. Adjustment models were used to account for age, gender, diabetes mellitus, use of antiplatelet agents, and preexisting cardiovascular disease, and stratified by pre-dialysis CKD stages 3-5 vs. ESRD. Findings: During 5.8 years of follow-up, unadjusted mortality risk was higher in CKD patients on warfarin therapy (hazard ratio [HR] 2.34 with 95% CI 1.25-4.39; p < 0.01). After multivariate adjustment and stratification by CKD stage, the mortality risk remained significant in ESRD patients receiving warfarin (HR 6.62 with 95% CI 2.56-17.16; p < 0.001). Furthermore, adjusted rates of significant bleeding (incident rate ratio, IRR 3.57 with 95% CI 1.51-8.45; p < 0.01) and myocardial infarction (IRR 4.20 with 95% CI 1.78-9.91; p < 0.01) were higher among warfarin users. No differences in rates of ischemic or hemorrhagic strokes were found between the 2 groups. Conclusions: Warfarin use was associated with several-fold higher risk of death, bleeding, and myocardial infarction in dialysis patients. If additional studies suggest similar associations, the use of warfarin in dialysis patients warrants immediate reconsideration.

scholarly journals Association between Testosterone and Mortality Risk among U.S. Males Receiving Dialysis

2017 ◽  
Vol 46 (3) ◽  
pp. 195-203 ◽  
Author(s):  
Jerry Yu ◽  
Vanessa A. Ravel ◽  
Amy S. You ◽  
Elani Streja ◽  
Matthew B. Rivara ◽  
...  
Keyword(s):  
Mortality Risk ◽  
Case Mix ◽  
Total Testosterone ◽  
Testosterone Deficiency ◽  
Dialysis Patients ◽  
Cox Models ◽  
Testosterone Levels ◽  
All Cause Mortality ◽  
Nationally Representative ◽  
Underlying Mechanisms

Background: Among the general population, low circulating testosterone levels are associated with higher risk of cardiovascular disease and death. While testosterone deficiency is common in dialysis patients, studies of testosterone and mortality in this population are ambiguous and overlapping. We hypothesized that lower testosterone levels are associated with higher mortality in male dialysis patients. Methods: We examined a nationally representative cohort of male dialysis patients from a large US dialysis organization who underwent one or more total testosterone measurements from 1/2007 to 12/2011. The association between total testosterone categorized as quartiles and all-cause mortality was studied using Cox models adjusted for expanded case-mix and laboratory covariates. We also examined total testosterone as a continuous predictor of all-cause mortality using restricted cubic splines. Results: Among 624 male dialysis patients, 51% of patients demonstrated testosterone deficiency (total testosterone <300 ng/dL); median (IQR) total testosterone levels were 297 (190-424) ng/mL. In expanded case-mix + laboratory adjusted Cox analyses, we observed a graded association between lower testosterone levels and higher mortality risk (ref: quartile 3): adjusted hazard ratios (95% CI) 2.32 (1.33-4.06), 1.80 (0.99-3.28), and 0.68 (0.32-1.42) for Quartiles 1, 2, and 4, respectively. In adjusted spline analyses, the lower testosterone-higher mortality risk association declined with higher testosterone levels until the value reached a threshold of 400 ng/dL above which risk plateaued. Conclusion: Lower testosterone levels were independently associated with higher mortality risk in male dialysis patients. Further studies are needed to determine underlying mechanisms, and whether testosterone replacement ameliorates death risk in this population.

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