Dialysis Transition Patterns of Chronic Kidney Disease Patients With and Without Heart Failure.

IF 6.9 2区医学 Q1 MEDICINE, GENERAL & INTERNAL

Mayo Clinic proceedings Pub Date : 2025-02-13 DOI:10.1016/j.mayocp.2024.11.029

Mitchell E Flagg, Simran K Bhandari, Katherine J Pak, Hui Zhou, Sally F Shaw, Jiaxiao M Shi, Connie M Rhee, Benjamin I Broder, John J Sim

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引用次数: 0

Abstract

Objective: To compare dialysis transition patterns of chronic kidney disease (CKD) patients with heart failure (HF) and without HF, including inpatient "crash start" initiation of long-term ("maintenance") dialysis, early dialysis initiation as evaluated by estimated glomerular filtration rate (eGFR), and rate of central venous catheter (CVC) use for hemodialysis.

Methods: A cross-sectional study was performed within Kaiser Permanente Southern California of patients (age ≥18 years) with observed incidence of CKD who initiated maintenance dialysis between January 1, 2007, and December 31, 2018. Heart failure was further categorized into HF with preserved ejection fraction (>40%) or HF with reduced ejection fraction (≤40%). Associations between HF and risk of inpatient initiation of maintenance dialysis or hemodialysis vascular access were assessed by rate ratio (RR) using Poisson regression with robust variance error.

Results: Of 6812 patients with CKD initiating dialysis, 2498 (37%) had HF. Inpatient dialysis initiation occurred in 463 (18.5%) patients with HF vs 416 (9.6%) without HF. Mean (SD) eGFR at dialysis was 11.3 (6.2) mL/min per 1.73 m² with HF vs 9.4 (5.2) mL/min per 1.73 m² without HF (P<.001). Of 5499 patients who initiated hemodialysis, CVC use occurred in 1302 (58.5%) HF patients vs 1698 (51.9%) non-HF patients. Compared with non-HF patients, patients with HF had multivariate RRs (95% CI) of 1.46 (1.26 to 1.69) and 1.04 (0.99 to 1.10) for inpatient dialysis initiation and CVC use, respectively. Patients with HF with reduced ejection fraction had CVC placement RR of 1.23 (1.14 to 1.33).

Conclusion: Patients with CKD and HF had higher rates of suboptimal dialysis initiation: more frequent inpatient dialysis starts, more frequent CVC placement for hemodialysis access, and higher eGFR at dialysis initiation. Our findings suggest that CKD patients with HF may warrant different management strategies as they progress to dialysis.

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慢性肾病伴和不伴心力衰竭患者的透析过渡模式

目的：比较慢性肾脏疾病（CKD）合并心力衰竭（HF）和非HF患者的透析过渡模式，包括住院患者长期（“维持性”）透析的“突然启动”开始，通过估计肾小球滤过率（eGFR）评估的早期透析开始，以及中心静脉导管（CVC）用于血液透析的比率。方法：对2007年1月1日至2018年12月31日期间开始维护性透析的CKD患者（年龄≥18岁）进行横断面研究。心力衰竭进一步分为射血分数保持型HF （bb0 ~ 40%）和射血分数降低型HF（≤40%）。采用带稳健方差误差的泊松回归，通过率比（RR）评估HF与住院患者开始维持性透析或血液透析血管通路风险之间的关系。结果：6812例开始透析的CKD患者中，2498例（37%）有心衰。463例（18.5%）HF患者开始住院透析，416例（9.6%）非HF患者开始住院透析。透析时的平均（SD） eGFR为有HF的11.3 (6.2)mL/min / 1.73 m2 vs无HF的9.4 (5.2)mL/min / 1.73 m2。结论：CKD和HF患者有更高的次优透析起始率：更频繁的住院透析起始，更频繁的血液透析通道CVC放置，以及透析起始时更高的eGFR。我们的研究结果表明，CKD合并心衰患者可能需要不同的管理策略，因为他们进展到透析。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Mayo Clinic proceedings 医学-医学：内科

CiteScore

16.80

自引率

1.10%

发文量

383

审稿时长

37 days

期刊介绍： Mayo Clinic Proceedings is a premier peer-reviewed clinical journal in general medicine. Sponsored by Mayo Clinic, it is one of the most widely read and highly cited scientific publications for physicians. Since 1926, Mayo Clinic Proceedings has continuously published articles that focus on clinical medicine and support the professional and educational needs of its readers. The journal welcomes submissions from authors worldwide and includes Nobel-prize-winning research in its content. With an Impact Factor of 8.9, Mayo Clinic Proceedings is ranked #20 out of 167 journals in the Medicine, General and Internal category, placing it in the top 12% of these journals. It invites manuscripts on clinical and laboratory medicine, health care policy and economics, medical education and ethics, and related topics.