کد مقاله | کد نشریه | سال انتشار | مقاله انگلیسی | نسخه تمام متن |
---|---|---|---|---|
6160646 | 1249342 | 2014 | 12 صفحه PDF | دانلود رایگان |
عنوان انگلیسی مقاله ISI
An instrumental variable approach finds no associated harm or benefit with early dialysis initiation in the United States
ترجمه فارسی عنوان
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کلمات کلیدی
دیالیز، بیماری کلیوی در مرحله پایانی، اپیدمیولوژی و نتایج، نرخ فیلتراسیون گلومرولی،
موضوعات مرتبط
علوم پزشکی و سلامت
پزشکی و دندانپزشکی
بیماریهای کلیوی
چکیده انگلیسی
The estimated glomerular filtration rate (eGFR) at dialysis initiation has been rising. Observational studies suggest harm, but may be confounded by unmeasured factors. As instrumental variable methods may be less biased, we performed a retrospective cohort study of 310,932 patients who started dialysis between 2006 and 2008 and were registered in the United States Renal Data System in order to describe geographic variation in eGFR at dialysis initiation and determine its association with mortality. Patients were grouped into 804 health service areas (HSAs) by zip code. Individual eGFR at dialysis initiation averaged 10.8 ml/min per 1.73 m2 but varied geographically. Only 11% of the variation in mean HSA-level eGFR at dialysis initiation was accounted for by patient characteristics. We calculated demographic-adjusted mean eGFR at dialysis initiation in the HSAs using the 2006 and 2007 incident cohort as our instrument and estimated the association between individual eGFR at dialysis initiation and mortality in the 2008 incident cohort using the two-stage residual inclusion method. Among 89,547 patients starting dialysis in 2008 with eGFR 5-20 ml/min per 1.73 m2, eGFR at initiation was not associated with mortality over a median of 15.5 months (hazard ratio, 1.025 per 1 ml/min per 1.73 m2 for eGFR 5-14 ml/min per 1.73 m2; and 0.973 per 1 ml/min per 1.73 m2 for eGFR 14-20 ml/min per 1.73 m2). Thus, there was no associated harm or benefit with early dialysis initiation in the United States.
ناشر
Database: Elsevier - ScienceDirect (ساینس دایرکت)
Journal: Kidney International - Volume 86, Issue 4, October 2014, Pages 798-809
Journal: Kidney International - Volume 86, Issue 4, October 2014, Pages 798-809
نویسندگان
Julia J. Scialla, Jiannong Liu, Deidra C. Crews, Haifeng Guo, Karen Bandeen-Roche, Patti L. Ephraim, Navdeep Tangri, Stephen M. Sozio, Tariq Shafi, Dana C. Miskulin, Wieneke M. Michels, Bernard G. Jaar, Albert W. Wu, Neil R. Powe, L Ebony Boulware,