Nephrol Dial Transplant (2000) 15: 650-658
© 2000 European Renal Association-European Dialysis and Transplant Association
Predictors of hospitalization and death among pre-dialysis patients: a retrospective cohort study
1 Division of Nephrology and 2 Department of Community Health and Epidemiology, Queen's University, Kingston, Ontario, Canada
Background. Although there is abundant research describing predictors of patient morbidity and mortality among dialysis patients, predictors of adverse clinical outcomes among pre-dialysis patients are less well defined. The purpose of this study was to identify baseline predictors of first non-elective hospitalization among a retrospective cohort of 362 pre-dialysis patients.
Methods. Univariate and multivariate Cox proportional hazard models were used to identify predictors of hospitalization prior to dialysis initiation, adjusted for baseline creatinine level. Dialysis initiation, loss to follow-up, and study conclusion were censored events. Secondary outcomes included cause-specific hospitalization and death.
Results. Univariate analysis indicated that advanced age (RR 1.026, CI 1.016–1.037), number of prescribed anti-hypertensive medications (RR 1.149, CI 1.019–1.296), history of myocardial infarction (RR 1.979, CI 1.339–2.926), congestive heart failure (RR 2.299, CI 1.616–3.270), angina (RR 2.289, CI 1.695–3.091), peripheral vascular disease (RR 1.841, CI 1.282–2.644), renal failure secondary to nephrosclerosis (RR 1.413, CI 1.033–1.933) or renal artery stenosis (RR 1.587, CI 1.036–2.430), lower baseline haemoglobin level (RR 0.986, CI 0.979–0.992), and baseline creatinine greater than 300 µmol/l (RR 1.636, CI 1.233–2.171) were predictors of hospitalization. Gender, diabetes, diastolic blood pressure, mean arterial pressure, history of stroke, and hypoalbuminaemia did not predict outcome. Multivariate analysis, adjusted for baseline creatinine level, selected advanced age (RR 1.017, CI 1.006–1.027), angina (RR 1.893, CI 1.371–2.613), peripheral vascular disease (RR 1.545, CI 1.054–2.266), and haemoglobin level (RR 0.987, CI 0.944–0.979) as independent predictors of hospitalization.
Conclusion. Advanced age, co-morbid cardiovascular illness and anaemia are independent predictors of non-elective hospitalization prior to dialysis initiation. Further study is needed to determine the extent to which aggressive pre-dialysis management of anaemia and cardiovascular disease can improve patient outcomes.
Keywords: chronic renal insufficiency; morbidity; mortality; outcomes; pre-dialysis; progressive renal insufficiency
Correspondence and offprint requests to: David C. Holland, Suite 2058, Etherington Hall, Queen's University, Kingston, Ontario, Canada K7L 3N6.
CiteULike 
Connotea 
Del.icio.us What's this?
This article has been cited by other articles:
|
|
 |
|
  P. Lefebvre, M. S. Duh, S. Buteau, B. Bookhart, and S. H. Mody Medical Costs of Untreated Anemia in Elderly Patients with Predialysis Chronic Kidney Disease J. Am. Soc. Nephrol., December 1, 2006; 17(12): 3497 - 3502. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. N. Foley Do We Know the Correct Hemoglobin Target for Anemic Patients with Chronic Kidney Disease? Clin. J. Am. Soc. Nephrol., July 1, 2006; 1(4): 678 - 684. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 R. Vanholder, Z. Massy, A. Argiles, G. Spasovski, F. Verbeke, N. Lameire, and for the European Uremic Toxin Work Group (EUTox) Chronic kidney disease as cause of cardiovascular morbidity and mortality Nephrol. Dial. Transplant., June 1, 2005; 20(6): 1048 - 1056. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
Y. Shibagaki and A. Shetty Anaemia is common after kidney transplantation, especially among African Americans Nephrol. Dial. Transplant., September 1, 2004; 19(9): 2368 - 2373. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
M. C. Thomas, R. J. MacIsaac, C. Tsalamandris, L. Molyneaux, I. Goubina, G. Fulcher, D. Yue, and G. Jerums The burden of anaemia in type 2 diabetes and the role of nephropathy: a cross-sectional audit Nephrol. Dial. Transplant., July 1, 2004; 19(7): 1792 - 1797. [Abstract] [Full Text] [PDF]
|
|
|
|
 |
|
 W. Metcalfe, I.H. Khan, G.J. Prescott, K. Simpson, and A.M. Macleod Hospitalization in the first year of renal replacement therapy for end-stage renal disease QJM, December 1, 2003; 96(12): 899 - 909. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Levin The advantage of a uniform terminology and staging system for chronic kidney disease (CKD) Nephrol. Dial. Transplant., August 1, 2003; 18(8): 1446 - 1451. [Full Text] [PDF]
|
|
|
|
|
|
A. Levin The advantage of a uniform terminology and staging system for chronic kidney disease (CKD) Nephrol. Dial. Transplant., August 1, 2003; 18(88): 1446 - 1451. [Full Text]
|
|
|
|
 |
|
 M. C. Thomas, R. J. MacIsaac, C. Tsalamandris, D. Power, and G. Jerums Unrecognized Anemia in Patients With Diabetes: A cross-sectional survey Diabetes Care, April 1, 2003; 26(4): 1164 - 1169. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
D. S. Silverberg, D. Wexler, M. Blum, J. Z. Tchebiner, D. Sheps, G. Keren, D. Schwartz, R. Baruch, T. Yachnin, M. Shaked, et al. The effect of correction of anaemia in diabetics and non-diabetics with severe resistant congestive heart failure and chronic renal failure by subcutaneous erythropoietin and intravenous iron Nephrol. Dial. Transplant., January 1, 2003; 18(1): 141 - 146. [Abstract] [Full Text] [PDF]
|
|
|
|
|
|
A. Levin The role of anaemia in the genesis of cardiac abnormalities in patients with chronic kidney disease Nephrol. Dial. Transplant., February 1, 2002; 17(2): 207 - 210. [Full Text] [PDF]
|
|
|
|
|
|
I. Ledebo, M. Kessler, W. van Biesen, C. Wanner, A. Wiecek, S. Prichard, A. Argiles, and E. Ritz Initiation of dialysis--opinions from an international survey: Report on the Dialysis Opinion Symposium at the ERA-EDTA Congress, 18 September 2000, Nice Nephrol. Dial. Transplant., June 1, 2001; 16(6): 1132 - 1138. [Full Text] [PDF]
|
|