Evidence map›Paper›PMID 32021471›Full record

ArticleClinical epidemiology2020

Estimating the Fraction of First-Year Hemodialysis Deaths Attributable to Potentially Modifiable Risk Factors: Results from the DOPPS.

Angelo Karaboyas, Hal Morgenstern, Yun Li, Brian A Bieber, Raymond Hakim, Takeshi Hasegawa, Michel Jadoul, Elke Schaeffner, Raymond Vanholder, Ronald L Pisoni and 2 more

Abstract read
PubMed Full text at PMC Publisher
In one paragraph

Article in Clinical epidemiology, 2020. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 8 papers.

0numbers the graph read from it
0cells of the map it votes in
8citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

8 citing papers in PubMed.

  1. Review
  2. Article
  3. Smoothing transition to dialysis to improve early outcomes after dialysis initiation among old and frail adults-a narrative review.Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association · 2022
    Review
  4. Review
  5. Article
  6. Slipping Through the Pores: Hypoalbuminemia and Albumin Loss During Hemodialysis.International journal of nephrology and renovascular disease · 2021
    Review
  7. Article
  8. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

12 authors.

Angelo KaraboyasArbor Research Collaborative for Health, Ann Arbor, MI, USA.ORCID 0000-0001-8846-5360
Hal MorgensternDepartments of Epidemiology and Environmental Health Sciences, School of Public Health, and Department of Urology, Medical School, University of Michigan, Ann Arbor, MI, USA.
Yun LiDepartment of Biostatistics, University of Michigan School of Public Health, Ann Arbor, MI, USA.
Brian A BieberArbor Research Collaborative for Health, Ann Arbor, MI, USA.ORCID 0000-0001-8505-0979
Raymond HakimVanderbilt University Medical Center, Nashville, TN, USA.
Takeshi HasegawaDivision of Nephrology, Department of Medicine, Showa University Fujigaoka Hospital, Yokohama, Japan, and Showa University Research Administration Center (SURAC), Showa University, Tokyo, Japan.
Michel JadoulCliniques universitaires St Luc, Université Catholique de Louvain, Brussels, Belgium.
Elke SchaeffnerInstitute of Public Health, Charité - Universitätsmedizin Berlin, Berlin, Germany.
Raymond VanholderDepartment of Nephrology, University Hospital Ghent, Ghent, Belgium.
Ronald L PisoniArbor Research Collaborative for Health, Ann Arbor, MI, USA.
Friedrich K PortDepartment of Epidemiology, University of Michigan School of Public Health, and Department of Internal Medicine-Nephrology, University of Michigan Medical School, Ann Arbor, MI, USA.
Bruce M RobinsonArbor Research Collaborative for Health, Ann Arbor, MI, USA.

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

purposeMortality among first-year hemodialysis (HD) patients remains unacceptably high. To address this problem, we estimate the proportions of early HD deaths that are potentially preventable by modifying known risk factors.

methodsWe included 15,891 HD patients (within 60 days of starting HD) from 21 countries in the Dialysis Outcomes and Practice Patterns Study (1996-2015), a prospective cohort study. Using Cox regression adjusted for potential confounders, we estimated the fraction of first-year deaths attributable to one or more of twelve modifiable risk factors (the population attributable fraction, AF) identified from the published literature by comparing predicted survival based on risk factors observed vs counterfactually set to reference levels.

resultsThe highest AFs were for catheter use (22%), albumin <3.5 g/dL (19%), and creatinine <6 mg/dL (12%). AFs were 5%-9% for no pre-HD nephrology care, no residual urine volume, systolic blood pressure <130 or ≥160 mm Hg, phosphorus <3.5 or ≥5.5 mg/dL, hemoglobin <10 or ≥12 g/dL, and white blood cell count >10,000/μL. AFs for ferritin, calcium, and PTH were <3%. Overall, 65% (95% CI: 59%-71%) of deaths were attributable to these 12 risk factors. Additionally, the AF for C-reactive protein >10 mg/L was 21% in facilities where it was routinely measured.

conclusionA substantial proportion of first-year HD deaths could be prevented by successfully modifying a few risk factors. Highest priorities should be decreasing catheter use and limiting malnutrition/inflammation whenever possible.

Indexed as

attributable fractioncohort studyhemodialysisincidencemortality

Identifiers

PMID32021471
PMCPMC6974411

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Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the OpenQuestion graph.