Annual Improvement in RKF and you can Success
Cox regression analyses with restricted cubic spline functions showed a significant association of annual change in renal CLurea with all-cause mortality in the minimally adjusted, case mix–adjusted, and fully Hayward escort adjusted models ( Figure 2 ); patients with faster CLurea decline showed higher risks of mortality. Case mix–adjusted HRs were 2.00 (95% CI, 1.55 to 2.59), 1.25 (95% CI, 1.16 to 1.35), 0.81 (95% CI, 0.73 to 0.91), and 0.61 (95% CI, 0.50 to 0.74) at ?6.0, ?3.0, ±0.0, and +3.0 ml/min per 1.73 m 2 per year of change in CLurea, respectively (reference: ?1.5 ml/min per 1.73 m 2 per year). These associations were robust against additional adjustment for baseline ultrafiltration rate and its annual change. Consistent trends were observed in subgroup analyses according to baseline CLurea ( Figure 3 ). Rapid CLurea decline (>3.0 ml/min per 1.73 m 2 per year) also showed a case mix–adjusted HR of 1.62 (95% CI, 1.27 to 2.07) for all-cause mortality. This association was not modified by baseline age (?65 or <65 years old), sex, race (white or nonwhite), diabetes, presence of congestive heart failure, hemoglobin (?11.5 or <11.5 g/dl), serum albumin (?3.6 or <3.6 g/dl), and serum phosphorus (?5.0 or <5.0 mg/dl; Ptelecommunications>0.20 for all) ( Figure 4 ).
Distributions and you may minimal cubic splines researching the relationship of annual change during the residual renal CL
urea with all-cause mortality among 6538 incident hemodialysis patients (2007–2010): (A) baseline renal CLurea adjustment model, (B) case mix adjustment model, (C) fully adjusted model, and (D) additional adjustment for baseline ultrafiltration rate (UFr) and its annual change on the fully adjusted model. Annual changes in renal CLurea were calculated subtracting values at year 1 (the fifth patient-quarter; the first 91 days of the second year of dialysis) from those at baseline (the first patient-quarter; the first 91 days of the first year of dialysis). Dashed and solid lines represent HR estimates and 95% CIs, respectively.
Distributions and case mix–adjusted all–cause death HRs of annual change in renal CLurea by using restricted cubic splines among 6538 incident hemodialysis patients (2007–2010) stratified by baseline CLurea levels: (A) <1.5 ml/min per 1.73 m 2 , (B) 1.5 to <3.0 ml/min per 1.73 m 2 , (C) 3.0 to <6.0 ml/min per 1.73 m 2 , and (D) ?6.0 ml/min per 1.73 m 2 . Annual changes in renal CLurea were calculated subtracting values at year 1 (the fifth patient-quarter; the first 91 days of the second year of dialysis) from those at baseline (the first patient-quarter; the first 91 days of the first year of dialysis). Dashed and solid lines represent HR estimates and 95% CIs, respectively.
Overall and subgroup analyses of associations between rapid decline in residual renal CLurea >3 ml/min per 1.73 m 2 per year and all-cause mortality among 6538 incident hemodialysis patients (2007–2010) in the case mix adjustment model. Annual changes in renal CLurea were calculated subtracting values at year 1 (the fifth patient-quarter; the first 91 days of the second year of dialysis) from those at baseline (the first patient-quarter; the first 91 days of the first year of dialysis). Points and bars represent HR estimates and 95% CIs, respectively. Alb, albumin; CHF, congestive heart failure; Hgb, hemoglobin; Phos, phosphorus.
Median baseline urine volume was 900 (IQR, 550–1400) ml/d (Supplemental Table 3). Median urine volume at year 1 was 650 (IQR, 380–1100) ml/d, and mean±SD annual change in urine volume was ?240±610 ml/dpared with factors related to annual decline in CLurea, older age, non-Hispanic black, diabetes, presence of congestive heart failure, lower body mass index, lower serum albumin, higher serum creatinine, and higher serum phosphorus were consistently associated with faster decline in urine volume, irrespective of the adjustment model. Women, lower serum calcium, and higher serum bicarbonate also showed significant relationships to faster annual decline in the fully adjusted model (Supplemental Table 4). These findings were confirmed in the sensitivity analyses, where patients with baseline urine volume <300 ml/d were excluded (Supplemental Table 5).