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Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the French REIN registry using a multi-state model.

Beuscart JB, Pagniez D, Boulanger E, Duhamel A - J Epidemiol (2014)

Bottom Line: Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group.The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Biostatistics, EA2694, Lille School of Medicine, Lille2 University.

ABSTRACT

Background: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration.

Methods: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death.

Results: During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.

Conclusions: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.

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Related in: MedlinePlus

Probabilities of being in a given state at each follow-up time point, estimated by the Aalen-Johansen estimator. Probabilities are stacked. For example, the 2-year probabilities were estimated at 7.7% for the waiting list (yellow), 9.6% for renal transplantation (RT, green), 0.2% for death while on the waiting list (black), 28.9% for death while not wait-listed (red), and 53.6% for being alive on HD and not wait-listed (blue). The sum of these probabilities is 1.00 at each time point.
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fig02: Probabilities of being in a given state at each follow-up time point, estimated by the Aalen-Johansen estimator. Probabilities are stacked. For example, the 2-year probabilities were estimated at 7.7% for the waiting list (yellow), 9.6% for renal transplantation (RT, green), 0.2% for death while on the waiting list (black), 28.9% for death while not wait-listed (red), and 53.6% for being alive on HD and not wait-listed (blue). The sum of these probabilities is 1.00 at each time point.

Mentions: In the multi-state model, the initial state of all the patients corresponded to the ‘HD, not wait-listed’ state. The probabilities of being in a given state at each follow-up time point, as estimated by the Aalen-Johansen estimator, are shown in Figure 2. The probability of remaining not wait-listed and alive on HD was only 33.2% four years after the initiation of HD; the probability of remaining not wait-listed and dying was estimated at 46.0% (Figure 2). Thus, patients who remained not wait-listed had a very high probability of death on HD.


Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the French REIN registry using a multi-state model.

Beuscart JB, Pagniez D, Boulanger E, Duhamel A - J Epidemiol (2014)

Probabilities of being in a given state at each follow-up time point, estimated by the Aalen-Johansen estimator. Probabilities are stacked. For example, the 2-year probabilities were estimated at 7.7% for the waiting list (yellow), 9.6% for renal transplantation (RT, green), 0.2% for death while on the waiting list (black), 28.9% for death while not wait-listed (red), and 53.6% for being alive on HD and not wait-listed (blue). The sum of these probabilities is 1.00 at each time point.
© Copyright Policy - open-access
Related In: Results  -  Collection

License
Show All Figures
getmorefigures.php?uid=PMC4310874&req=5

fig02: Probabilities of being in a given state at each follow-up time point, estimated by the Aalen-Johansen estimator. Probabilities are stacked. For example, the 2-year probabilities were estimated at 7.7% for the waiting list (yellow), 9.6% for renal transplantation (RT, green), 0.2% for death while on the waiting list (black), 28.9% for death while not wait-listed (red), and 53.6% for being alive on HD and not wait-listed (blue). The sum of these probabilities is 1.00 at each time point.
Mentions: In the multi-state model, the initial state of all the patients corresponded to the ‘HD, not wait-listed’ state. The probabilities of being in a given state at each follow-up time point, as estimated by the Aalen-Johansen estimator, are shown in Figure 2. The probability of remaining not wait-listed and alive on HD was only 33.2% four years after the initiation of HD; the probability of remaining not wait-listed and dying was estimated at 46.0% (Figure 2). Thus, patients who remained not wait-listed had a very high probability of death on HD.

Bottom Line: Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group.The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients.

View Article: PubMed Central - PubMed

Affiliation: Department of Biostatistics, EA2694, Lille School of Medicine, Lille2 University.

ABSTRACT

Background: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration.

Methods: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death.

Results: During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.

Conclusions: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.

Show MeSH
Related in: MedlinePlus