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
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| creator | Chang, Yun-Lun Wang, Jie-Sian Yeh, Hung-Chieh Ting, I-Wen Huang, Han-Chun Chiang, Hsiu-Yin Hsiao, Chiung-Tzu Chu, Pei-Lun Kuo, Chin-Chi |
| description | The optimal timing to initiate dialysis among patients with an estimated glomerular filtration rate (eGFR) of |
| doi_str_mv | 10.1371/journal.pone.0233124 |
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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.</description><identifier>ISSN: 1932-6203</identifier><identifier>EISSN: 1932-6203</identifier><identifier>DOI: 10.1371/journal.pone.0233124</identifier><identifier>PMID: 32401817</identifier><language>eng</language><publisher>United States: Public Library of Science</publisher><subject>Accreditation ; Adolescent ; Adult ; Aged ; Aged, 80 and over ; Albumin ; Anti-inflammatory agents ; Antibiotics ; Antihypertensives ; Bicarbonates ; Big Data ; Biology and Life Sciences ; Carbon dioxide ; Carbonates ; Care and treatment ; Chronic kidney failure ; Computer centers ; Confidence intervals ; Creatinine ; Dialysis ; Diseases ; Diuretics ; Epidermal growth factor receptors ; Female ; Fluid management ; Glomerular filtration rate ; Glycosylated hemoglobin ; Hemodialysis ; Hemoglobin ; Hemoglobins ; Hospitals ; Humans ; Indicators ; Inflammation ; Internal medicine ; Kidney diseases ; Laboratories ; Male ; Medical research ; Medical schools ; Medicine ; Medicine and Health Sciences ; Methods ; Middle Aged ; Mortality ; Nephrology ; Nonsteroidal anti-inflammatory drugs ; Observational studies ; Observational Studies as Topic ; Patient outcomes ; Patients ; Phosphorus ; Potassium ; Prevention ; Proportional Hazards Models ; Renal Dialysis - methods ; Serum albumin ; Steroidal anti-inflammatory agents ; Time ; Time Factors ; Urea ; Young Adult</subject><ispartof>PloS one, 2020-05, Vol.15 (5), p.e0233124-e0233124</ispartof><rights>COPYRIGHT 2020 Public Library of Science</rights><rights>2020 Chang et al. This is an open access article distributed under the terms of the Creative Commons Attribution License: http://creativecommons.org/licenses/by/4.0/ (the “License”), which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited. Notwithstanding the ProQuest Terms and Conditions, you may use this content in accordance with the terms of the License.</rights><rights>2020 Chang et al 2020 Chang et al</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c692t-5c77286d2142aef52e9b645ef0f83bcb79781eb78c441608d92c998e0349f9db3</citedby><cites>FETCH-LOGICAL-c692t-5c77286d2142aef52e9b645ef0f83bcb79781eb78c441608d92c998e0349f9db3</cites><orcidid>0000-0002-2050-1377</orcidid></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219782/pdf/$$EPDF$$P50$$Gpubmedcentral$$Hfree_for_read</linktopdf><linktohtml>$$Uhttps://www.ncbi.nlm.nih.gov/pmc/articles/PMC7219782/$$EHTML$$P50$$Gpubmedcentral$$Hfree_for_read</linktohtml><link.rule.ids>230,314,727,780,784,864,885,2102,2928,23866,27924,27925,53791,53793,79600,79601</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32401817$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><contributor>Andreucci, Michele</contributor><creatorcontrib>Chang, Yun-Lun</creatorcontrib><creatorcontrib>Wang, Jie-Sian</creatorcontrib><creatorcontrib>Yeh, Hung-Chieh</creatorcontrib><creatorcontrib>Ting, I-Wen</creatorcontrib><creatorcontrib>Huang, Han-Chun</creatorcontrib><creatorcontrib>Chiang, Hsiu-Yin</creatorcontrib><creatorcontrib>Hsiao, Chiung-Tzu</creatorcontrib><creatorcontrib>Chu, Pei-Lun</creatorcontrib><creatorcontrib>Kuo, Chin-Chi</creatorcontrib><title>Dialysis timing may be deferred toward very late initiation: An observational study</title><title>PloS one</title><addtitle>PLoS One</addtitle><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.</description><subject>Accreditation</subject><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Albumin</subject><subject>Anti-inflammatory agents</subject><subject>Antibiotics</subject><subject>Antihypertensives</subject><subject>Bicarbonates</subject><subject>Big Data</subject><subject>Biology and Life Sciences</subject><subject>Carbon dioxide</subject><subject>Carbonates</subject><subject>Care and treatment</subject><subject>Chronic kidney failure</subject><subject>Computer centers</subject><subject>Confidence intervals</subject><subject>Creatinine</subject><subject>Dialysis</subject><subject>Diseases</subject><subject>Diuretics</subject><subject>Epidermal growth factor receptors</subject><subject>Female</subject><subject>Fluid management</subject><subject>Glomerular filtration rate</subject><subject>Glycosylated hemoglobin</subject><subject>Hemodialysis</subject><subject>Hemoglobin</subject><subject>Hemoglobins</subject><subject>Hospitals</subject><subject>Humans</subject><subject>Indicators</subject><subject>Inflammation</subject><subject>Internal medicine</subject><subject>Kidney diseases</subject><subject>Laboratories</subject><subject>Male</subject><subject>Medical research</subject><subject>Medical schools</subject><subject>Medicine</subject><subject>Medicine and Health Sciences</subject><subject>Methods</subject><subject>Middle Aged</subject><subject>Mortality</subject><subject>Nephrology</subject><subject>Nonsteroidal anti-inflammatory drugs</subject><subject>Observational studies</subject><subject>Observational Studies as Topic</subject><subject>Patient outcomes</subject><subject>Patients</subject><subject>Phosphorus</subject><subject>Potassium</subject><subject>Prevention</subject><subject>Proportional Hazards Models</subject><subject>Renal Dialysis - methods</subject><subject>Serum albumin</subject><subject>Steroidal anti-inflammatory agents</subject><subject>Time</subject><subject>Time Factors</subject><subject>Urea</subject><subject>Young 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timing may be deferred toward very late initiation: An observational study</title><author>Chang, Yun-Lun ; Wang, Jie-Sian ; Yeh, Hung-Chieh ; Ting, I-Wen ; Huang, Han-Chun ; Chiang, Hsiu-Yin ; Hsiao, Chiung-Tzu ; Chu, Pei-Lun ; Kuo, Chin-Chi</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c692t-5c77286d2142aef52e9b645ef0f83bcb79781eb78c441608d92c998e0349f9db3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2020</creationdate><topic>Accreditation</topic><topic>Adolescent</topic><topic>Adult</topic><topic>Aged</topic><topic>Aged, 80 and over</topic><topic>Albumin</topic><topic>Anti-inflammatory agents</topic><topic>Antibiotics</topic><topic>Antihypertensives</topic><topic>Bicarbonates</topic><topic>Big Data</topic><topic>Biology and Life Sciences</topic><topic>Carbon dioxide</topic><topic>Carbonates</topic><topic>Care and treatment</topic><topic>Chronic kidney failure</topic><topic>Computer centers</topic><topic>Confidence intervals</topic><topic>Creatinine</topic><topic>Dialysis</topic><topic>Diseases</topic><topic>Diuretics</topic><topic>Epidermal growth factor receptors</topic><topic>Female</topic><topic>Fluid management</topic><topic>Glomerular filtration rate</topic><topic>Glycosylated hemoglobin</topic><topic>Hemodialysis</topic><topic>Hemoglobin</topic><topic>Hemoglobins</topic><topic>Hospitals</topic><topic>Humans</topic><topic>Indicators</topic><topic>Inflammation</topic><topic>Internal medicine</topic><topic>Kidney diseases</topic><topic>Laboratories</topic><topic>Male</topic><topic>Medical research</topic><topic>Medical schools</topic><topic>Medicine</topic><topic>Medicine and Health Sciences</topic><topic>Methods</topic><topic>Middle Aged</topic><topic>Mortality</topic><topic>Nephrology</topic><topic>Nonsteroidal anti-inflammatory drugs</topic><topic>Observational studies</topic><topic>Observational Studies as Topic</topic><topic>Patient 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one</jtitle><addtitle>PLoS One</addtitle><date>2020-05-13</date><risdate>2020</risdate><volume>15</volume><issue>5</issue><spage>e0233124</spage><epage>e0233124</epage><pages>e0233124-e0233124</pages><issn>1932-6203</issn><eissn>1932-6203</eissn><abstract>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.</abstract><cop>United States</cop><pub>Public Library of Science</pub><pmid>32401817</pmid><doi>10.1371/journal.pone.0233124</doi><tpages>e0233124</tpages><orcidid>https://orcid.org/0000-0002-2050-1377</orcidid><oa>free_for_read</oa></addata></record> |
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| recordid | cdi_plos_journals_2402401177 |
| source | MEDLINE; DOAJ Directory of Open Access Journals; Public Library of Science (PLoS) Journals Open Access; EZB-FREE-00999 freely available EZB journals; PubMed Central; Free Full-Text Journals in Chemistry |
| subjects | Accreditation Adolescent Adult Aged Aged, 80 and over Albumin Anti-inflammatory agents Antibiotics Antihypertensives Bicarbonates Big Data Biology and Life Sciences Carbon dioxide Carbonates Care and treatment Chronic kidney failure Computer centers Confidence intervals Creatinine Dialysis Diseases Diuretics Epidermal growth factor receptors Female Fluid management Glomerular filtration rate Glycosylated hemoglobin Hemodialysis Hemoglobin Hemoglobins Hospitals Humans Indicators Inflammation Internal medicine Kidney diseases Laboratories Male Medical research Medical schools Medicine Medicine and Health Sciences Methods Middle Aged Mortality Nephrology Nonsteroidal anti-inflammatory drugs Observational studies Observational Studies as Topic Patient outcomes Patients Phosphorus Potassium Prevention Proportional Hazards Models Renal Dialysis - methods Serum albumin Steroidal anti-inflammatory agents Time Time Factors Urea Young Adult |
| title | Dialysis timing may be deferred toward very late initiation: An observational study |
| url | https://sfx.bib-bvb.de/sfx_tum?ctx_ver=Z39.88-2004&ctx_enc=info:ofi/enc:UTF-8&ctx_tim=2025-01-02T08%3A19%3A47IST&url_ver=Z39.88-2004&url_ctx_fmt=infofi/fmt:kev:mtx:ctx&rfr_id=info:sid/primo.exlibrisgroup.com:primo3-Article-gale_plos_&rft_val_fmt=info:ofi/fmt:kev:mtx:journal&rft.genre=article&rft.atitle=Dialysis%20timing%20may%20be%20deferred%20toward%20very%20late%20initiation:%20An%20observational%20study&rft.jtitle=PloS%20one&rft.au=Chang,%20Yun-Lun&rft.date=2020-05-13&rft.volume=15&rft.issue=5&rft.spage=e0233124&rft.epage=e0233124&rft.pages=e0233124-e0233124&rft.issn=1932-6203&rft.eissn=1932-6203&rft_id=info:doi/10.1371/journal.pone.0233124&rft_dat=%3Cgale_plos_%3EA623752658%3C/gale_plos_%3E%3Curl%3E%3C/url%3E&disable_directlink=true&sfx.directlink=off&sfx.report_link=0&rft_id=info:oai/&rft_pqid=2402401177&rft_id=info:pmid/32401817&rft_galeid=A623752658&rft_doaj_id=oai_doaj_org_article_11baa869f84246b6bfd87062a9e41ccb&rfr_iscdi=true |