Dialysis timing may be deferred toward very late initiation: An observational study.
The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0-30 days be...
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doaj-11baa869f84246b6bfd87062a9e41ccb2021-03-03T21:49:41ZengPublic Library of Science (PLoS)PLoS ONE1932-62032020-01-01155e023312410.1371/journal.pone.0233124Dialysis timing may be deferred toward very late initiation: An observational study.Yun-Lun ChangJie-Sian WangHung-Chieh YehI-Wen TingHan-Chun HuangHsiu-Yin ChiangChiung-Tzu HsiaoPei-Lun ChuChin-Chi KuoThe optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0-30 days before dialysis initiation [DI]) and control (90-120 days before DI) periods was conducted in 1,079 hemodialysis patients aged 18-90 years at China Medical University Hospital between 2006 and 2015. The uremic burden was quantified based on 7 uremic indicators that reached the predefined threshold in case period, namely hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate. Dialysis timing was classified as standard (met 0-2 uremic indicators), late (3-5 indicators), and very late (6-7 indicators). Median eGFR-DI of the 1,079 patients was 3.4 mL/min/1.73 m2 and was 2.7 mL/min/1.73 m2 in patients with very late initiation. The median follow-up duration was 2.42 years. Antibiotics, diuretics, antihypertensive medications, and non-steroidal anti-inflammatory drugs (NSAIDs) were more prevalently used during the case period. The fully adjusted hazards ratios of all-cause mortality for the late and very late groups were 0.97 (95% confidence interval 0.76-1.24) and 0.83 (0.61-1.15) compared with the standard group. It is safe to defer dialysis initiation among patients with chronic kidney disease (CKD) having an eGFR of <5 mL/min/1.73 m2 even when patients having multiple biochemical uremic burdens. Coordinated efforts in acute infection prevention, optimal fluid management, and prevention of accidental exposure to NSAIDs are crucial to prolong the dialysis-free survival.https://doi.org/10.1371/journal.pone.0233124 |
collection |
DOAJ |
language |
English |
format |
Article |
sources |
DOAJ |
author |
Yun-Lun Chang Jie-Sian Wang Hung-Chieh Yeh I-Wen Ting Han-Chun Huang Hsiu-Yin Chiang Chiung-Tzu Hsiao Pei-Lun Chu Chin-Chi Kuo |
spellingShingle |
Yun-Lun Chang Jie-Sian Wang Hung-Chieh Yeh I-Wen Ting Han-Chun Huang Hsiu-Yin Chiang Chiung-Tzu Hsiao Pei-Lun Chu Chin-Chi Kuo Dialysis timing may be deferred toward very late initiation: An observational study. PLoS ONE |
author_facet |
Yun-Lun Chang Jie-Sian Wang Hung-Chieh Yeh I-Wen Ting Han-Chun Huang Hsiu-Yin Chiang Chiung-Tzu Hsiao Pei-Lun Chu Chin-Chi Kuo |
author_sort |
Yun-Lun Chang |
title |
Dialysis timing may be deferred toward very late initiation: An observational study. |
title_short |
Dialysis timing may be deferred toward very late initiation: An observational study. |
title_full |
Dialysis timing may be deferred toward very late initiation: An observational study. |
title_fullStr |
Dialysis timing may be deferred toward very late initiation: An observational study. |
title_full_unstemmed |
Dialysis timing may be deferred toward very late initiation: An observational study. |
title_sort |
dialysis timing may be deferred toward very late initiation: an observational study. |
publisher |
Public Library of Science (PLoS) |
series |
PLoS ONE |
issn |
1932-6203 |
publishDate |
2020-01-01 |
description |
The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of <5 mL/min/1.73 m2 is unknown. We hypothesized that dialysis initiation time can be deferred in this population even with high uremic burden. A case-crossover study with case (0-30 days before dialysis initiation [DI]) and control (90-120 days before DI) periods was conducted in 1,079 hemodialysis patients aged 18-90 years at China Medical University Hospital between 2006 and 2015. The uremic burden was quantified based on 7 uremic indicators that reached the predefined threshold in case period, namely hemoglobin, serum albumin, blood urea nitrogen, serum creatinine, potassium, phosphorus, and bicarbonate. Dialysis timing was classified as standard (met 0-2 uremic indicators), late (3-5 indicators), and very late (6-7 indicators). Median eGFR-DI of the 1,079 patients was 3.4 mL/min/1.73 m2 and was 2.7 mL/min/1.73 m2 in patients with very late initiation. The median follow-up duration was 2.42 years. Antibiotics, diuretics, antihypertensive medications, and non-steroidal anti-inflammatory drugs (NSAIDs) were more prevalently used during the case period. The fully adjusted hazards ratios of all-cause mortality for the late and very late groups were 0.97 (95% confidence interval 0.76-1.24) and 0.83 (0.61-1.15) compared with the standard group. It is safe to defer dialysis initiation among patients with chronic kidney disease (CKD) having an eGFR of <5 mL/min/1.73 m2 even when patients having multiple biochemical uremic burdens. Coordinated efforts in acute infection prevention, optimal fluid management, and prevention of accidental exposure to NSAIDs are crucial to prolong the dialysis-free survival. |
url |
https://doi.org/10.1371/journal.pone.0233124 |
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