Background
Methods
Study population and study design
Exposure of interest
Primary and secondary outcomes
Covariates
Statistical analyses
Results
Baseline characteristics of study cohort
Variable | All | Poor functional status | Good functional status | P value |
---|---|---|---|---|
Number of Subjects | 49,645 | 9295 (18.7%) | 40,350 (81.3%) | |
Mortality, % | ||||
90-Day | 11.6 | 19.3 | 9.8 | < 0.001 |
1-Year | 31.2 | 46.4 | 27.7 | < 0.001 |
Demographics | ||||
Age (years) | 72 (11) | 73 (11) | 71 (11) | < 0.001 |
18–29 | 0.2 | 0.2 | 0.2 | < 0.001 |
30–39 | 1.2 | 0.8 | 1.2 | |
40–49 | 3.4 | 2.4 | 3.6 | |
50–59 | 9.1 | 8.3 | 9.3 | |
60–69 | 23.6 | 21.1 | 24.2 | |
70–79 | 36.9 | 35.3 | 37.3 | |
80–89 | 23.6 | 28.9 | 22.4 | |
90–100 | 2.0 | 3.0 | 1.8 | |
Octogenarians, % | 25.6 | 31.9 | 24.2 | < 0.001 |
Body mass index (kg/m2) | 28.7 (7.7) | 28.9 (8.4) | 28.6 (7.5) | 0.002 |
< 18.5 | 3.7 | 4.9 | 3.4 | < 0.001 |
18.5–24.99 | 31.8 | 32.0 | 31.8 | |
25–30 | 28.5 | 25.4 | 29.3 | |
> 30 | 34.4 | 35.8 | 34.0 | |
Missing | 1.6 | 1.9 | 1.6 | |
Male, % | 54.6 | 48.8 | 55.9 | < 0.001 |
Race, % | 0.59 | |||
Hispanic | 9.3 | 9.7 | 9.2 | |
White | 62.3 | 61.8 | 62.4 | |
Black | 24.5 | 24.6 | 24.5 | |
Asian | 3.0 | 2.9 | 3.0 | |
Native American | 0.9 | 1.0 | 0.9 | |
Comorbidities, % | ||||
Congestive heart failure | 40.8 | 52.8 | 38.0 | < 0.001 |
ASHD | 42.9 | 53.6 | 40.4 | < 0.001 |
Hypertension | 85.2 | 86.5 | 84.9 | < 0.001 |
Diabetes mellitus | 56.2 | 63.4 | 54.5 | < 0.001 |
Cancer | 9.8 | 10.7 | 9.5 | < 0.001 |
Amputation | 3.5 | 8.1 | 2.5 | < 0.001 |
Peripheral vascular disease | 18.1 | 26.4 | 16.2 | < 0.001 |
TIA/CVA | 12.4 | 21.0 | 10.4 | < 0.001 |
COPD | 12.6 | 18.7 | 11.2 | < 0.001 |
Dialysis modality, % | ||||
Hemodialysis | 95.9 | 98.4 | 95.3 | < 0.001 |
Peritoneal dialysis | 4.1 | 1.6 | 4.7 | |
Hemodialysis access, % | ||||
AV access | 17.7 | 10.7 | 19.3 | < 0.001 |
Central venous catheter | 82.3 | 89.3 | 80.7 | |
Maturing AV access (among CVC) | 21.4 | 17.2 | 22.4 | < 0.001 |
Laboratory variables from within 45-day period prior to most recent ESRD episode | ||||
Albumin, g/dL | 3.1 (0.7) | 2.9 (0.7) | 3.2 (0.7) | < 0.001 |
< 3.5 | 51.8 | 60.5 | 49.7 | < 0.001 |
≥ 3.5 | 25.3 | 16.8 | 27.2 | |
Missing | 23.0 | 22.7 | 23.0 | |
Hemoglobin, g/dL | 10.0 (1.5) | 9.9 (1.5) | 10.1 (1.5) | < 0.001 |
< 11 | 68.3 | 71.8 | 67.5 | < 0.001 |
11–12 | 15.1 | 13.3 | 15.5 | |
> 12 | 8.5 | 8.0 | 8.6 | |
Missing | 8.1 | 6.9 | 8.4 | |
Dialysis setting, % | ||||
Dialysis facility | 95.0 | 95.7 | 94.8 | < 0.001 |
Home | 4.3 | 1.9 | 4.8 | |
Skilled nursing facility | 0.7 | 2.3 | 0.4 | |
Employment status, % | ||||
Unemployed | 11.1 | 10.5 | 11.2 | < 0.001 |
Employed + others | 5.9 | 5.0 | 6.1 | |
Retired-age | 61.6 | 61.0 | 61.7 | |
Retired-disability | 21.4 | 23.5 | 20.9 | |
Acute hospitalization during 2- year pre-ESRD | ||||
Frequency, % | 88.9 | 93.8 | 87.8 | < 0.001 |
Total length of stay (days) | 23 (28) | 36 (36) | 20 (25) | < 0.001 |
Pre-dialysis nephrology care, % | ||||
None | 27.8 | 35.3 | 26.1 | < 0.001 |
< 12 months | 33.0 | 28.2 | 34.2 | |
> 12 months | 26.3 | 21.3 | 27.5 | |
Unknown | 12.8 | 15.1 | 12.3 | |
Cause of end stage renal disease, % | ||||
Diabetes mellitus | 45.9 | 49.7 | 45.1 | < 0.001 |
Hypertension/LVD | 32.3 | 29.9 | 32.8 | |
Malignancy | 2.6 | 2.0 | 2.8 | |
Cystic/hereditary | 1.3 | 0.6 | 1.4 | |
Secondary GN /vasculits | 1.2 | 0.9 | 1.3 | |
Glomerulonephritis | 3.9 | 2.2 | 4.3 | |
Interstitial nephritis/pyelonephritis | 2.9 | 2.8 | 2.9 | |
Others | 9.8 | 11.8 | 9.3 | |
Cause of death (among patients with 1-year mortality), % | ||||
Cardiovascular | 38.2 | 37.1 | 38.7 | < 0.001 |
Infection | 10.0 | 12.1 | 9.2 | |
Malignancy | 4.5 | 3.1 | 5.0 | |
Withdrawal of dialysis | 11.6 | 11.6 | 11.7 | |
Unknown/others | 35.6 | 36.1 | 35.4 | |
History of nursing home, % | 10.3 | 38.2 | 3.9 | < 0.001 |
Provision of transplant information, % | 65.6 | 55.5 | 67.9 | < 0.001 |
Primary and secondary outcomes
Variable | All | Death ≤ 1 year | Death > 1 year | P value |
---|---|---|---|---|
Number of Subjects | 49,645 | 15,513 (31.2%) | 34,132 (68.8%) | |
Functional status, % | ||||
Poor functional status | 18.7 | 27.8 | 14.6 | < 0.001 |
Demographics | ||||
Age (years) | 72 (11) | 75 (10) | 70 (12) | < 0.001 |
18–29 | 0.2 | 0.1 | 0.3 | < 0.001 |
30–39 | 1.2 | 0.5 | 1.4 | |
40–49 | 3.4 | 1.7 | 4.2 | |
50–59 | 9.1 | 5.7 | 10.6 | |
60–69 | 23.6 | 18.2 | 26.1 | |
70–79 | 36.9 | 38.1 | 36.3 | |
80–89 | 23.6 | 32.1 | 19.7 | |
90–100 | 2.0 | 3.4 | 1.4 | |
Octogenarians, % | 25.6 | 35.6 | 21.1 | < 0.001 |
Body mass index, kg/m2 | 28.7 (7.7) | 7.5 | 29.1 (7.7) | < 0.001 |
< 18.5 | 3.7 | 5.2 | 3.0 | < 0.001 |
18.5–24.99 | 31.8 | 36.5 | 29.7 | |
25–30 | 28.5 | 27.2 | 29.1 | |
> 30 | 34.4 | 29.5 | 36.6 | |
Missing | 1.6 | 1.7 | 1.6 | |
Male, % | 54.6 | 55.6 | 54.1 | 0.003 |
Race, % | < 0.001 | |||
Hispanic | 9.3 | 7.1 | 10.3 | |
White | 62.3 | 70.2 | 58.7 | |
Black | 24.5 | 19.5 | 26.7 | |
Asian | 3.0 | 2.3 | 3.3 | |
Native American | 0.9 | 0.8 | 1.0 | |
Comorbidities, % | ||||
Congestive heart failure | 40.8 | 49.1 | 37.0 | < 0.001 |
ASHD | 42.9 | 48.7 | 40.2 | < 0.001 |
Hypertension | 85.2 | 81.3 | 87.0 | < 0.001 |
Diabetes mellitus | 56.2 | 52.4 | 57.9 | < 0.001 |
Cancer | 9.8 | 12.5 | 8.5 | < 0.001 |
Amputations | 3.5 | 3.8 | 3.4 | 0.03 |
Peripheral vascular disease | 18.1 | 20.7 | 16.9 | < 0.001 |
TIA/CVA | 12.4 | 14.0 | 11.6 | < 0.001 |
COPD | 12.6 | 16.8 | 10.7 | < 0.001 |
Dialysis modality, % | ||||
Hemodialysis | 95.9 | 97.7 | 95.0 | < 0.001 |
Peritoneal dialysis | 4.1 | 2.3 | 5.0 | |
Hemodialysis access, % | ||||
AV access | 17.7 | 9.1 | 21.6 | < 0.001 |
Central venous catheter | 82.3 | 90.9 | 78.4 | |
Maturing AV access (among CVC) | 21.4 | 15.1 | 24.7 | < 0.001 |
Laboratory variables from within 45-day period prior to most recent ESRD episode | ||||
Albumin, g/dL | 3.1 (0.7) | 3.0 (0.7) | 3.2 (0.7) | < 0.001 |
< 3.5 | 51.8 | 57.6 | 49.1 | |
≥ 3.5 | 25.3 | 18.4 | 28.4 | < 0.001 |
Missing | 23.0 | 24.0 | 22.5 | |
Hemoglobin, g/dL | 10.0 (1.5) | 10.0 (1.5) | 10.1 (1.5) | |
< 11 | 68.3 | 69.1 | 67.9 | |
11–12 | 15.1 | 13.9 | 15.7 | |
> 12 | 8.5 | 8.3 | 8.6 | 0.05 |
Missing | 8.1 | 8.7 | 7.8 | < 0.001 |
Dialysis setting, % | ||||
Dialysis facility | 95.0 | 96.2 | 94.5 | < 0.001 |
Home | 4.3 | 2.5 | 5.1 | |
Skilled nursing facility | 0.7 | 1.3 | 0.5 | |
Employment status, % | ||||
Unemployed | 11.1 | 10.2 | 11.5 | < 0.001 |
Employed + others | 5.9 | 4.7 | 6.4 | |
Retired-age | 61.6 | 68.3 | 58.5 | |
Retired-disability | 21.4 | 16.7 | 23.5 | |
Acute hospitalization during 2 year Pre-ESRD | ||||
Frequency, % | 88.9 | 93.4 | 86.9 | < 0.001 |
Total length of stay (days) | 23.3 (27.9) | 31.1 (32.3) | 19.7 (24.9) | < 0.001 |
Pre-dialysis nephrology care, % | ||||
None | 27.8 | 35.0 | 24.5 | < 0.001 |
< 12 months | 33.0 | 29.3 | 34.8 | |
> 12 months | 26.3 | 20.0 | 29.2 | |
Unknown | 12.8 | 15.7 | 11.5 | |
Cause of end stage renal disease, % | ||||
Diabetes mellitus | 45.9 | 40.8 | 48.3 | < 0.001 |
Hypertension/LVD | 32.3 | 34.1 | 31.5 | |
Malignancy | 2.6 | 4.2 | 1.9 | |
Cystic/hereditary | 1.3 | 0.7 | 1.5 | |
Secondary GN/vasculits | 1.2 | 1.1 | 1.3 | |
Glomerulonephritis | 3.9 | 2.8 | 4.4 | |
Interstitial nephritis/pyelonephritis | 2.9 | 2.9 | 2.8 | |
Others | 9.8 | 13.3 | 8.2 | |
History of nursing home, % | 10.3 | 18.0 | 6.8 | < 0.001 |
Provision of transplant information, % | 65.6 | 57.9 | 69.1 | < 0.001 |
Variablea | Odds ratio (95% CI) |
---|---|
Poor functional status | 1.48 (1.40, 1.56) |
Dialysis access | |
Central venous catheter | 1.84 (1.72, 1.97) |
Peritoneal dialysis | 1.24 (1.08, 1.42) |
Age ≥ 80 years | 1.65 (1.57, 1.73) |
Body mass index, kg/m2 | |
< 18.5 | 1.82 (1.64, 2.03) |
18.5–25 | 1.34 (1.27, 1.41) |
25–30 | 1.10 (1.04, 1.16) |
Missing | 1.19 (1.01, 1.40) |
Females | 0.94 (0.91, 0.99) |
Race | |
Asians | 0.63 (0.55, 0.71) |
Blacks | 0.68 (0.65, 0.72) |
Hispanics | 0.65 (0.60, 0.70) |
Native Americans | 0.83 (0.67, 1.03) |
History of nursing home | 1.80 (1.67, 1.92) |
Unemployment | 1.04 (0.98, 1.12) |
Comorbidities | |
Congestive heart failure | 1.37 (1.32, 1.44) |
Atherosclerotic heart disease | 1.11 (1.07, 1.16) |
Hypertension/large vessel disease | 0.72 (0.68, 0.77) |
Diabetes mellitus | 0.97 (0.92, 1.03) |
Cancer | 1.27 (1.19, 1.36) |
Amputation | 0.98 (0.88, 1.10) |
Peripheral vascular disease | 1.10 (1.04, 1.16) |
CVA/TIA | 1.06 (1.00, 1.13) |
Chronic obstructive pulmonary disease | 1.29 (1.22, 1.37) |
Albumin, g/dL | |
< 3.5 | 1.42 (1.35, 1.50) |
Missing | 1.33 (1.25, 1.41) |
Hemoglobin, g/dL | |
< 11 | 0.93 (0.87, 1.01) |
11–12 | 0.90 (0.83, 0.99) |
Missing | 1.06 (0.96, 1.17) |
Pre-dialysis acute hospitalization | 1.31 (1.21, 1.42) |
Cause of ESRD | |
Cystic/hereditary | 0.71 (0.57, 0.88) |
Glomerulonephritis | 0.76 (0.68, 0.86) |
Hypertension/large vessel disease | 1.08 (1.02, 1.14) |
Interstitial nephritis/pyelonephritis | 0.97 (0.85, 1.10) |
Others/unknown | 1.26 (1.17, 1.36) |
Malignancy | 2.07 (1.82, 2.35) |
Vasculits/secondary GN | 0.96 (0.79, 1.16) |
Pre-dialysis nephrology care | |
0–12 months | 0.78 (0.74, 0.82) |
> 12 months | 0.70 (0.66, 0.74) |
Unknown | 1.05 (0.99, 1.12) |
Access to transplant information | 0.81 (0.77, 0.84) |
Variablea | Odds ratio (95% CI) |
---|---|
Poor functional status | 1.39 (1.16, 1.66) |
Age ≥ 80 years | 1.70 (1.50, 1.94) |
Body mass index, kg/m2 | |
< 18.5 | 0.92 (0.81, 1.04) |
18.5–25 | 0.85 (0.76, 0.96) |
25–30 | 1.27 (0.93, 1.75) |
Missing | 0.88 (0.60, 1.29) |
Females | 0.93 (0.85, 1.02) |
Race | |
Asians | 1.15 (0.90, 1.48) |
Blacks | 1.88 (1.65, 2.14) |
Hispanics | 1.56 (1.30, 1.88) |
Native Americans | 0.94 (0.60, 1.45) |
History of nursing home | 3.86 (2.54, 5.85) |
Unemployment | 1.09 (0.93, 1.28) |
Comorbidities | |
Congestive heart failure | 1.35 (1.21, 1.51) |
Atherosclerotic heart disease | 1.01 (0.91, 1.12) |
Hypertension | 0.96 (0.84, 1.11) |
Diabetes mellitus | 0.97 (0.86, 1.11) |
Cancer | 1.01 (0.86, 1.89) |
Peripheral vascular disease | 1.08 (0.95, 1.24) |
CVA/TIA | 0.95 (0.81, 1.10) |
Chronic obstructive pulmonary disease | 1.40 (1.18, 1.67) |
Albumin, g/dL | |
< 3.5 | 2.15 (1.93, 2.40) |
Missing | 1.42 (1.25, 1.61) |
Hemoglobin, g/dL | |
< 11 | 1.86 (1.63, 2.14) |
11–12 | 1.16 (0.99, 1.36) |
Missing | 1.49 (1.21, 1.83) |
Pre-dialysis acute hospitalization | 2.61 (2.35, 2.90) |
Cause of ESRD | |
Cystic/hereditary | 0.82 (0.61, 1.10) |
Glomerulonephritis | 0.61 (0.50, 0.75) |
Hypertension/large vessel disease | 0.92 (0.80, 1.05) |
Interstitial nephritis/pyelonephritis | 1.19 (0.88, 1.60) |
Others/unknown | 1.15 (0.92, 1.43) |
Malignancy | 1.05 (0.75, 1.47) |
Vasculits/secondary GN | 0.83 (0.55, 1.25) |
Pre-dialysis nephrology care | |
0–12 months | 0.23 (0.19, 0.28) |
> 12 months | 0.23 (0.19, 0.28) |
Unknown | 0.67 (0.52, 0.88) |
Access to transplant information | 0.50 (0.44, 0.56) |
Variablea | Odds ratio (95% CI) |
---|---|
Poor functional status | 0.79 (0.72, 0.86) |
Age ≥ 80 years | 0.88 (0.82, 0.93) |
Body mass index, kg/m2 | |
< 18.5 | 0.96 (0.82, 1.11) |
18.5–25 | 0.97 (0.91, 1.04) |
25–30 | 1.03 (0.96, 1.10) |
Missing | 1.02 (0.83, 1.27) |
Females | 0.83 (0.79, 0.88) |
Race | |
Asians | 0.94 (0.81, 1.10) |
Blacks | 1.10 (1.03, 1.17) |
Hispanics | 0.81 (0.74, 0.90) |
Native Americans | 0.88 (0.67, 1.17) |
History of nursing home | 0.71 (0.63, 0.80) |
Unemployment | 1.06 (0.98, 1.16) |
Comorbidities | |
Congestive heart failure | 0.75 (0.71, 0.80) |
Atherosclerotic heart disease | 0.92 (0.87, 0.97) |
Hypertension | 1.18 (1.09, 1.28) |
Diabetes mellitus | 0.96 (0.89, 1.03) |
Cancer | 0.97 (0.87, 1.06) |
Amputation | 0.88 (0.75, 1.03) |
Peripheral vascular disease | 1.02 (0.95, 1.09) |
CVA/TIA | 1.36 (0.95, 1.12) |
Chronic obstructive pulmonary disease | 0.87 (0.79, 0.94) |
Albumin, g/dL | |
< 3.5 | 0.52 (0.49, 0.55) |
Missing | 0.58 (0.54, 0.63) |
Hemoglobin, g/dL | |
< 11 | 0.87 (0.79, 0.95) |
11–12 | 1.18 (1.06, 1.31) |
Missing | 0.99 (0.87, 1.12) |
Pre-dialysis acute hospitalization | 0.41 (0.38, 0.44) |
Cause of ESRD | |
Cystic/hereditary | 1.40 (1.11, 1.66) |
Glomerulonephritis | 0.93 (0.82, 1.07) |
Hypertension/large vessel disease | 0.88 (0.82, 0.95) |
Interstitial nephritis/pyelonephritis | 0.83 (0.70, 0.98) |
Others/unknown | 0.52 (0.45, 0.59) |
Malignancy | 0.56 (0.46, 0.69) |
Vasculits/secondary GN | 0.52 (0.39, 0.70) |
Pre-dialysis nephrology care | |
0–12 months | 6.49 (5.86, 7.19) |
> 12 months | 11.42 (10.31, 12.65) |
Unknown | 1.77 (1.54, 2.04) |
Access to transplant information | 1.18 (1.12, 1.25) |