Dataset Information

Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-Cohort Study.

ABSTRACT: Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients. It remains unknown whether the modified Cr index predicts infection-related mortality in this population. We investigated the association between the modified Cr index and infection-related mortality. A total of 3046 patients registered in the Q-Cohort Study, a multicenter, observational study of HD patients, were analyzed. Associations between sex-specific quartiles (Q1-Q4) of the modified Cr index and the risk for infection-related mortality were analyzed by Cox proportional hazard model. During a median follow-up of 8.8 years, 387 patients died of infection. The estimated risk for infection-related mortality was significantly higher in the lower quartiles (Q1, Q2, and Q3) than in the highest quartile (Q4) as the reference group (hazard ratios and 95% confidence intervals [CI]: Q1, 2.89 [1.70-5.06], Q2, 2.76 [1.72-4.62], and Q3, 1.79 [1.12-2.99]). The hazard ratio (95% CI) for a 1?mg/kg/day decrease in the modified Cr index was 1.18 (1.09-1.27, P?

SUBMITTER: Arase H

PROVIDER: S-EPMC6985259 | biostudies-literature | 2020 Jan

REPOSITORIES: biostudies-literature

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Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-Cohort Study.

Arase Hokuto H Yamada Shunsuke S Hiyamuta Hiroto H Taniguchi Masatomo M Tokumoto Masanori M Tsuruya Kazuhiko K Nakano Toshiaki T Kitazono Takanari T

Scientific reports 20200127 1

Modified creatinine (Cr) index, calculated by age, sex, pre-dialysis serum Cr concentration, and Kt/V for urea, is an indicator of skeletal muscle mass in hemodialysis (HD) patients. It remains unknown whether the modified Cr index predicts infection-related mortality in this population. We investigated the association between the modified Cr index and infection-related mortality. A total of 3046 patients registered in the Q-Cohort Study, a multicenter, observational study of HD patients, were a ...[more]

PMID: 31988325

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Project description:BackgroundFew data are available regarding the long-term mortality rate for patients receiving nocturnal home hemodialysis.Study designPosttrial observational study.Setting & participantsFrequent Hemodialysis Network (FHN) Nocturnal Trial participants who consented to extended follow-up.InterventionThe FHN Nocturnal Trial randomly assigned 87 individuals to 6-times-weekly home nocturnal hemodialysis or 3-times-weekly hemodialysis for 1 year. Patients were enrolled starting in March 2006 and follow-up was completed by May 2010. After the 1-year trial concluded, FHN Nocturnal participants were free to modify their hemodialysis prescription.Outcomes & measurementsWe obtained dates of death and kidney transplantation through July 2011 using linkage to the US Renal Data System and queries of study centers. We used log-rank tests and Cox regression to relate mortality to the initial randomization assignment.ResultsMedian follow-up for the trial and posttrial observational period was 3.7 years. In the nocturnal arm, there were 2 deaths during the 12-month trial period and an additional 12 deaths during the extended follow-up. In the conventional arm, the numbers of deaths were 1 and 4, respectively. In the nocturnal dialysis group, the overall mortality HR was 3.88 (95% CI, 1.27-11.79; P=0.01). Using as-treated analysis with a 12-month running treatment average, the HR for mortality was 3.06 (95% CI, 1.11-8.43; P=0.03). Six-month running treatment data analysis showed an HR of 1.12 (95% CI, 0.44-3.22; P=0.7).LimitationsThese results should be interpreted cautiously due to a surprisingly low (0.03 deaths/patient-year) mortality rate for individuals randomly assigned to conventional home hemodialysis, low statistical power for the mortality comparison due to the small sample size, and the high rate of hemodialysis prescription changes.ConclusionsPatients randomly assigned to nocturnal hemodialysis had a higher mortality rate than those randomly assigned to conventional dialysis. The implications of this result require further investigation.

Project description:The bioelectrical impedance analysis-measured ratio of extracellular water (ECW) to intracellular water (ICW) reflects fluid volume and malnutrition. It may be an indicator of protein-energy wasting and muscle wasting in hemodialysis patients. We examined the association between the ECW/ICW ratio and simplified creatinine index, which is a new surrogate marker of protein-energy wasting and muscle wasting, and whether their combination can accurately predict mortality. A total of 224 patients undergoing hemodialysis for more than 6 months and having undergone bioelectrical impedance analysis for the assessment of body composition were included. Patients were divided into two groups based on the cut-off values of the ECW/ICW ratio (0.57) and simplified creatinine index (20.4 mg/kg/day) for maximumly predicting mortality. Thereafter, they were cross-classified into four groups with each cut-off point. The ECW/ICW ratio was independently associated with the simplified creatinine index (β = -0.164; P = 0.042). During a follow-up of 3.5 years (2.0-6.0 years), 77 patients died. A higher ECW/ICW ratio (adjusted hazard ratio, 3.66, 95% confidence interval 1.99-6.72, P <0.0001) and lower simplified creatinine index (adjusted hazard ratio, 2.25, 95% confidence interval 1.34-3.79, P = 0.0021) were independently associated with an increased risk of all-cause mortality. The adjusted hazard ratio for the higher ECW/ICW ratio and lower simplified creatinine index group vs. the lower ECW/ICW ratio and higher simplified creatinine index group was 12.22 (95% confidence interval 3.68-40.57, p <0.0001). Furthermore, the addition of the ECW/ICW ratio and simplified creatinine index to the baseline risk model significantly improved the C-index from 0.831 to 0.864 (p = 0.045). In conclusion, the ECW/ICW ratio may be a surrogate marker of muscle wasting. Moreover, combining the ECW/ICW ratio and simplified creatinine index may improve the accuracy of predicting all-cause mortality and help stratify the mortality risk of hemodialysis patients.

Dataset Information

Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-Cohort Study.

Publications

Modified creatinine index and risk for long-term infection-related mortality in hemodialysis patients: ten-year outcomes of the Q-Cohort Study.

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