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• W3154332212 abstract "End stage kidney disease (ESKD) is a major global problem and the incidence is increasing worldwide. Patients receiving dialysis have a lower quality of life, require frequent medical interventions and have high mortality rates. Accurate and reliable prognostic information among patients receiving dialysis is important to facilitate shared decision making regarding burdensome investigations and treatments. The long-term risk of death among patients who survive beyond 6 months of dialysis commencement has not been explored in Australia and New Zealand. We aimed to develop a model to predict the risk of death at 3 years after commencing dialysis among patients that have survived 6 months on dialysis in Australia and New Zealand. We used the Australian and New Zealand Dialysis and Transplant (ANZDATA) registry to follow 17,596 patients aged >15 years, who commenced haemodialysis or peritoneal dialysis between 1st January 2006 and 31st December 2011, up until 31st December 2014. Overall 1048 patients (6%) died within the first 6 months. Of the 16,548 survivors, 2542 received a kidney transplant, 89 had native renal recovery and 59 were lost to follow up before reaching 3 years of follow up, and were censored. Basic demographic data, comorbidities, clinical measurements and kidney-disease specific variables were routinely collected using a standardized electronic survey form distributed to each dialysis unit across Australia and New Zealand. Patients with missing covariate data were excluded (n=112). Multivariable logistic regression was used to model the risk of death at 3 years. Predictor variables were selected in a stepwise fashion using backwards elimination. Area under the curve was used as a measure of discrimination of the model. Calibration was measured using a goodness of fit test. The study cohort consisted of 13,755 patients. Mean age at dialysis commencement was 62 years, 60% were male, and 69% were white. The three most common causes of ESKD were diabetes mellitus (40%), glomerulonephritis (20%), and hypertension (15%). Chronic lung disease (19%), coronary artery disease (45%), peripheral vascular disease (28%), cerebrovascular disease (16%) and type 2 diabetes (49%) were common. At 3 years, 3912 patients (28%) had died. Predictors of death included age (OR 1.14 per 5 years, 95% CI 1.12-1.16), white race (OR 1.5, 95% CI 1.31-1.79), low BMI (OR 1.45, 95% CI 1.13-1.87), ESKD caused by paraprotein or amyloid disease (OR 3.12, 95% CI 2.43-4.14), late referral to nephrology (OR 1.16, 95% CI 1.06-1.28), chronic lung disease (OR 1.31, 95% CI 1.19-1.45), coronary artery disease (OR 1.36, 95% CI 1.24-1.48), peripheral vascular disease (OR 1.26, 95% CI 1.15-1.38), cerebrovascular disease (OR 1.36, 95% CI 1.23-1.51) and type 1 diabetes mellitus (OR 1.90, 95% CI 1.45-2.51). Area under the ROC curve of the model was 0.724. Calibration was acceptable (Figure 1; Hosmer-Lemeshow statistic 10.2, p=0.25). Three-year survival in patients who survived the first six months of dialysis was 72%. As expected, those with significant comorbidities had poorer survival. A risk equation will be developed to assist clinicians, patients and caregivers with discussions about prognosis." @default.
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• W3154332212 date "2021-04-01" @default.
• W3154332212 modified "2023-09-27" @default.
• W3154332212 title "POS-535 RISK OF DEATH AT 3 YEARS AMONG PATIENTS THAT HAVE SURVIVED THE FIRST 6 MONTHS OF DIALYSIS IN AUSTRALIA AND NEW ZEALAND" @default.
• W3154332212 doi "https://doi.org/10.1016/j.ekir.2021.03.563" @default.
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