Mortality and Hospitalizations among Sickle Cell Disease Patients with End-Stage Kidney Disease Initiating Dialysis
| Autor: | Lorien S. Dalrymple, Nwamaka D. Eneanya, Sophia H. Zhao, Sagar U. Nigwekar, Norma J. Ofsthun, Ravi Thadhani, Franklin W. Maddux, Kabir O. Olaniran |
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| Rok vydání: | 2020 |
| Předmět: |
Adult
Male congenital hereditary and neonatal diseases and abnormalities medicine.medical_specialty medicine.medical_treatment Anemia Sickle Cell Rate ratio Cohort Studies Renal Dialysis hemic and lymphatic diseases Internal medicine medicine Humans Risk factor Dialysis Aged business.industry Hazard ratio Middle Aged medicine.disease Confidence interval Hospitalization Nephrology Kidney Failure Chronic Female Diagnosis code business Kidney disease Cohort study |
| Zdroj: | American Journal of Nephrology. 51:995-1003 |
| ISSN: | 1421-9670 0250-8095 |
| DOI: | 10.1159/000513012 |
| Popis: | Background: Sickle cell disease (SCD) is the most common inherited hematological disorder and a well-described risk factor for end-stage kidney disease (ESKD). Mortality and hospitalizations among patients with SCD who develop ESKD remain understudied. Furthermore, prior studies focused only on SCD patients where ESKD was caused by SCD. We aimed to describe mortality and hospitalization risk in all SCD patients initiating dialysis and explore risk factors for mortality and hospitalization. Methods: We performed a national observational cohort study of African American ESKD patients initiating dialysis (2000–2014) in facilities affiliated with a large dialysis provider. SCD was identified by diagnosis codes and matched to a reference population (non-SCD) by age, sex, dialysis initiation year, and geographic region of care. Sensitivity analyses were conducted by restricting to patients where SCD was recorded as the cause of ESKD. Results: We identified 504 SCD patients (mean age: 47 ± 14 years; 48% females) and 1,425 reference patients (mean age: 46 ± 14 years; 49% females). The median follow-up was 2.4 (IQR 1.0–4.5) years. Compared to the reference, SCD was associated with higher mortality risk (hazard ratio 1.66; 95% confidence interval [CI]: 1.36–2.03) and higher hospitalization rates (incidence rate ratio 2.12; 95% CI: 1.88–2.38) in multivariable analyses. Exploratory multivariable mortality risk models showed the largest mortality risk attenuation with the addition of time-varying hemoglobin and high-dose erythropoietin, but the association of SCD with mortality remained significant. Sensitivity analyses (restricted to ESKD caused by SCD) also showed significant associations between SCD and mortality and hospitalizations, but with larger effect estimates. High-dose erythropoietin was associated with the highest risk for mortality and hospitalization in SCD. Conclusions: Among ESKD patients, SCD is associated with a higher risk for mortality and hospitalization, particularly in patients where SCD is identified as the cause of ESKD. |
| Databáze: | OpenAIRE |
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