https://scholars.lib.ntu.edu.tw/handle/123456789/589423
標題: | Impact of weaning from acute dialytic therapy on outcomes of chronic kidney disease following urgent-start dialysis | 作者: | YUNG-MING CHEN WEN-YI LI VIN-CENT WU Wang Y.-C. Hwang S.-J. Lin S.-H. KWAN-DUN WU |
公開日期: | 2015 | 出版社: | Public Library of Science | 卷: | 10 | 期: | 4 | 起(迄)頁: | e0123386 | 來源出版物: | PLoS ONE | 摘要: | Discontinuation of acute, unplanned dialysis is always an important therapeutic goal in dialysis-requiring patients with existing chronic kidney disease. Only a limited proportion of patients could be weaned off dialysis and remained dialysis-free. Here we performed a multicenter, observational study to investigate factors associated with successful weaning from acute dialysis, and to explore the potential impact of weaning itself on outcomes of patients with chronic kidney disease following urgent-start dialysis. We recruited 440 chronic kidney disease patients with a baseline estimated glomerular filtration rate <45 ml/min per 1/73 m2, and used propensity score-adjusted Cox regression analysis to measure the effect of weaning from acute dialysis on death during the index hospitalization and death or readmission after discharge. Over 2 years, 64 of 421 (15.2%) patients who survived >1 month died, and 36 (8.6%) were removed from dialysis, with 26 (6.2%) remaining alive and dialysis-free. Logistic regression analysis found that age ? 65 years, ischemic acute tubular necrosis, nephrotoxic exposure, urinary obstruction, and higher predialysis estimated glomerular filtration rate and serum hemoglobin were predictors of weaning off dialysis. After adjustment for propensity scores for dialysis weaning, Cox proportional hazards models showed successful weaning from dialysis (adjusted hazard ratio 0.06; 95% confidence interval 0.01 to 0.35), along with a history of hypertension and serum albumin, were independent protectors for early death. Conversely, a history of stroke, peripheral arterial disease and cancer predicted the occurrence of early mortality. In conclusion, this prospective cohort study shows that compared to patients with chronic kidney disease who became end-stage renal disease after acute dialysis, patients who could be weaned off acute dialytic therapy were associated with reduced risk of premature death over a 2-year observation period. ? 2015 Chen et al. |
URI: | https://www.scopus.com/inward/record.uri?eid=2-s2.0-84927534635&doi=10.1371%2fjournal.pone.0123386&partnerID=40&md5=e274d3498ca33ca9673f2f3359bd19ed https://scholars.lib.ntu.edu.tw/handle/123456789/589423 |
ISSN: | 1932-6203 | DOI: | 10.1371/journal.pone.0123386 | SDG/關鍵字: | albumin; hemoglobin; hemoglobin; serum albumin; adult; aged; albumin blood level; Article; cerebrovascular accident; chronic kidney disease; clinical effectiveness; cohort analysis; controlled study; emergency treatment; end stage renal disease; estimated glomerular filtration rate; female; glomerulus filtration rate; hemoglobin blood level; hospital discharge; hospital readmission; hospitalization; human; hypertension; ischemic acute tubular necrosis; kidney disease; major clinical study; male; medical history; mortality; multicenter study; nephrotoxicity; observational study; outcome assessment; prediction; renal replacement therapy; risk reduction; survival time; therapy effect; treatment withdrawal; urinary tract obstruction; ambulatory care; blood; complication; coronary artery disease; hemodialysis; hypertension; kidney; metabolism; middle aged; pathology; prospective study; Renal Insufficiency, Chronic; risk factor; Adult; Aged; Ambulatory Care; Cohort Studies; Coronary Artery Disease; Female; Glomerular Filtration Rate; Hemoglobins; Humans; Hypertension; Kidney; Male; Middle Aged; Mortality; Prospective Studies; Renal Dialysis; Renal Insufficiency, Chronic; Risk Factors; Serum Albumin |
顯示於: | 醫學系 |
在 IR 系統中的文件,除了特別指名其著作權條款之外,均受到著作權保護,並且保留所有的權利。