Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout
Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout. Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-...
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| Veröffentlicht in: | Kidney international 2000-02, Vol.57 (2), p.691-696 |
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| creator | Misra, Madhukar Vonesh, Ed Churchill, David N. Moore, Harold L. Van Stone, John C. Nolph, Karl D. |
| description | Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased.
In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential.
This article highlights the significance of “informative censoring” when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis.
In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on |
| doi_str_mv | 10.1046/j.1523-1755.2000.00891.x |
| format | Article |
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Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased.
In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential.
This article highlights the significance of “informative censoring” when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis.
In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on the estimated trend. This analysis demonstrates that among PD patients, both the starting GFR and the rate of decline in GFR are associated with patient dropout. Consequently, future studies aimed at estimating the rate of decline in GFR among PD patients should also account for any dependencies between dropout and GFR. Similarly, data analyzing for apparent differences in the rate of decline of GFR between PD and HD should also adjust for possible informative censoring.</description><identifier>ISSN: 0085-2538</identifier><identifier>EISSN: 1523-1755</identifier><identifier>DOI: 10.1046/j.1523-1755.2000.00891.x</identifier><identifier>PMID: 10652048</identifier><identifier>CODEN: KDYIA5</identifier><language>eng</language><publisher>New York, NY: Elsevier Inc</publisher><subject>analysis of GFR ; Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy ; Biological and medical sciences ; dialysis ; Emergency and intensive care: renal failure. Dialysis management ; Glomerular Filtration Rate ; Humans ; informative censoring ; Intensive care medicine ; Kidney - physiology ; Kidney Failure, Chronic - mortality ; Kidney Failure, Chronic - physiopathology ; Kidney Failure, Chronic - therapy ; Longitudinal Studies ; Medical sciences ; Models, Statistical ; patient drop out ; Patient Dropouts - statistics & numerical data ; Peritoneal Dialysis - statistics & numerical data ; Renal Dialysis - statistics & numerical data ; residual renal function</subject><ispartof>Kidney international, 2000-02, Vol.57 (2), p.691-696</ispartof><rights>2000 International Society of Nephrology</rights><rights>2000 INIST-CNRS</rights><rights>Copyright Nature Publishing Group Feb 2000</rights><lds50>peer_reviewed</lds50><oa>free_for_read</oa><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c391x-c09ed07feac31c3c7883a40ff6eaab3cf48a563708281778ba558598c86eabb23</citedby><cites>FETCH-LOGICAL-c391x-c09ed07feac31c3c7883a40ff6eaab3cf48a563708281778ba558598c86eabb23</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,776,780,27901,27902</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=1288318$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/10652048$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Misra, Madhukar</creatorcontrib><creatorcontrib>Vonesh, Ed</creatorcontrib><creatorcontrib>Churchill, David N.</creatorcontrib><creatorcontrib>Moore, Harold L.</creatorcontrib><creatorcontrib>Van Stone, John C.</creatorcontrib><creatorcontrib>Nolph, Karl D.</creatorcontrib><title>Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout</title><title>Kidney international</title><addtitle>Kidney Int</addtitle><description>Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased.
In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential.
This article highlights the significance of “informative censoring” when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis.
In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on the estimated trend. This analysis demonstrates that among PD patients, both the starting GFR and the rate of decline in GFR are associated with patient dropout. Consequently, future studies aimed at estimating the rate of decline in GFR among PD patients should also account for any dependencies between dropout and GFR. Similarly, data analyzing for apparent differences in the rate of decline of GFR between PD and HD should also adjust for possible informative censoring.</description><subject>analysis of GFR</subject><subject>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</subject><subject>Biological and medical sciences</subject><subject>dialysis</subject><subject>Emergency and intensive care: renal failure. Dialysis management</subject><subject>Glomerular Filtration Rate</subject><subject>Humans</subject><subject>informative censoring</subject><subject>Intensive care medicine</subject><subject>Kidney - physiology</subject><subject>Kidney Failure, Chronic - mortality</subject><subject>Kidney Failure, Chronic - physiopathology</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Longitudinal Studies</subject><subject>Medical sciences</subject><subject>Models, Statistical</subject><subject>patient drop out</subject><subject>Patient Dropouts - statistics & numerical data</subject><subject>Peritoneal Dialysis - statistics & numerical data</subject><subject>Renal Dialysis - statistics & numerical data</subject><subject>residual renal function</subject><issn>0085-2538</issn><issn>1523-1755</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2000</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>BENPR</sourceid><recordid>eNqFkMFu1DAQhi0EotvCKyCrQtySjuM4cY6lKqVSpXIAiZvlOGNwlI23dtJu3x6HrGjFpadf8nz_aPwRQhnkDMrqrM-ZKHjGaiHyAgByANmwfP-KbP4NXpNNehVZIbg8Iscx9rBQHN6SIwaVKKCUG_LzW8CI4V5Pzo_UW_pr8FsM86ADtW6YwjpIgTRl5_TwGF2kD79xpLrr5zhhR60PdJdIHCfaBb_z8_SOvLF6iPj-kCfkx5fL7xdfs5vbq-uL85vM8IbtMwMNdlBb1IYzw00tJdclWFuh1i03tpRaVLwGWUhW17LVQkjRSCMT0LYFPyGf1r274O9mjJPaumhwGPSIfo4qNUUpqzqBp_-BvZ_DmG5TBQMGDTQ8QXKFTPAxBrRqF9xWh0fFQC3qVa8Ww2oxrBb16q96tU_VD4f9c7vF7llxdZ2AjwdAR6MHG_RoXHziivR1tmCfVwyTtXuHQUWTxBrsXEAzqc67l4_5A36Lot4</recordid><startdate>200002</startdate><enddate>200002</enddate><creator>Misra, Madhukar</creator><creator>Vonesh, Ed</creator><creator>Churchill, David N.</creator><creator>Moore, Harold L.</creator><creator>Van Stone, John C.</creator><creator>Nolph, Karl D.</creator><general>Elsevier Inc</general><general>Nature Publishing</general><general>Elsevier Limited</general><scope>6I.</scope><scope>AAFTH</scope><scope>IQODW</scope><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7QP</scope><scope>7RV</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>NAPCQ</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>PRINS</scope><scope>7X8</scope></search><sort><creationdate>200002</creationdate><title>Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout</title><author>Misra, Madhukar ; Vonesh, Ed ; Churchill, David N. ; Moore, Harold L. ; Van Stone, John C. ; Nolph, Karl D.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c391x-c09ed07feac31c3c7883a40ff6eaab3cf48a563708281778ba558598c86eabb23</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2000</creationdate><topic>analysis of GFR</topic><topic>Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy</topic><topic>Biological and medical sciences</topic><topic>dialysis</topic><topic>Emergency and intensive care: renal failure. Dialysis management</topic><topic>Glomerular Filtration Rate</topic><topic>Humans</topic><topic>informative censoring</topic><topic>Intensive care medicine</topic><topic>Kidney - physiology</topic><topic>Kidney Failure, Chronic - mortality</topic><topic>Kidney Failure, Chronic - physiopathology</topic><topic>Kidney Failure, Chronic - therapy</topic><topic>Longitudinal Studies</topic><topic>Medical sciences</topic><topic>Models, Statistical</topic><topic>patient drop out</topic><topic>Patient Dropouts - statistics & numerical data</topic><topic>Peritoneal Dialysis - statistics & numerical data</topic><topic>Renal Dialysis - statistics & numerical data</topic><topic>residual renal function</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Misra, Madhukar</creatorcontrib><creatorcontrib>Vonesh, Ed</creatorcontrib><creatorcontrib>Churchill, David N.</creatorcontrib><creatorcontrib>Moore, Harold L.</creatorcontrib><creatorcontrib>Van Stone, John C.</creatorcontrib><creatorcontrib>Nolph, Karl D.</creatorcontrib><collection>ScienceDirect Open Access Titles</collection><collection>Elsevier:ScienceDirect:Open Access</collection><collection>Pascal-Francis</collection><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Calcium & Calcified Tissue Abstracts</collection><collection>Nursing & Allied Health Database</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>Nursing & Allied Health Premium</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>ProQuest Central China</collection><collection>MEDLINE - Academic</collection><jtitle>Kidney international</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Misra, Madhukar</au><au>Vonesh, Ed</au><au>Churchill, David N.</au><au>Moore, Harold L.</au><au>Van Stone, John C.</au><au>Nolph, Karl D.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout</atitle><jtitle>Kidney international</jtitle><addtitle>Kidney Int</addtitle><date>2000-02</date><risdate>2000</risdate><volume>57</volume><issue>2</issue><spage>691</spage><epage>696</epage><pages>691-696</pages><issn>0085-2538</issn><eissn>1523-1755</eissn><coden>KDYIA5</coden><abstract>Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased.
In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential.
This article highlights the significance of “informative censoring” when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would still be valid. However, if the magnitude of the bias differs according to therapy, then additional adjustments would be needed to fairly compare the decline in GFR between PD and HD. Because this analysis is restricted to patients on PD, it would be scientifically incorrect to interpret previous studies solely on the basis of the results from this analysis.
In any longitudinal study designed to estimate trends in an outcome measured over time, it is important that the analysis of the data takes into account any effect patient dropout may have on the estimated trend. This analysis demonstrates that among PD patients, both the starting GFR and the rate of decline in GFR are associated with patient dropout. Consequently, future studies aimed at estimating the rate of decline in GFR among PD patients should also account for any dependencies between dropout and GFR. Similarly, data analyzing for apparent differences in the rate of decline of GFR between PD and HD should also adjust for possible informative censoring.</abstract><cop>New York, NY</cop><pub>Elsevier Inc</pub><pmid>10652048</pmid><doi>10.1046/j.1523-1755.2000.00891.x</doi><tpages>6</tpages><oa>free_for_read</oa></addata></record> |
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| subjects | analysis of GFR Anesthesia. Intensive care medicine. Transfusions. Cell therapy and gene therapy Biological and medical sciences dialysis Emergency and intensive care: renal failure. Dialysis management Glomerular Filtration Rate Humans informative censoring Intensive care medicine Kidney - physiology Kidney Failure, Chronic - mortality Kidney Failure, Chronic - physiopathology Kidney Failure, Chronic - therapy Longitudinal Studies Medical sciences Models, Statistical patient drop out Patient Dropouts - statistics & numerical data Peritoneal Dialysis - statistics & numerical data Renal Dialysis - statistics & numerical data residual renal function |
| title | Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout |
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