Posttransplant Hyponatremia Predicts Graft Failure and Mortality in Kidney Transplantation Recipients: A Multicenter Cohort Study in Korea - Fig 2

<p>Kaplan-Meier curves for the cumulative risks of acute rejection (A), graft failure (B), and all-cause mortality (C).</p

Baseline characteristics of the study subjects.

<p>Baseline characteristics of the study subjects.</p

Cancer in Korean patients with end-stage renal disease: A 7-year follow-up

<div><p>Background</p><p>The effectiveness of dialysis on the incidence of cancer in patients with end-stage renal disease (ESRD) remains to be clarified. In this study, we evaluated the incidence rate and type of cancer among patients with ESRD, compared to the general population, through a prospective 7-year follow-up. We also calculated the cumulative incidence rate of cancer associated with ESRD, with stratification to control for the competing risk of death.</p><p>Methods</p><p>This prospective observational cohort study was conducted using data from a nationwide study on patients with ESRD in Korea. A total of 5,235 patients, ≥18 years old, with ESRD were identified from the national registry as being treated by dialysis between August 2008 and December 2014. The standardized incidence ratio (SIR) and cumulative incidence rate of specific cancers were evaluated and compared to the general population.</p><p>Results</p><p>A total of 5,235 participants were included. During the 7 year observation period, 116 (2.2%) participants had been diagnosed as cancer. The SIR of overall cancer was 0.94 [95% confidence interval (CI), 0.72–1.19] and was comparable to the rate for the general population. Although the digestive organs were the most frequent site of a primary site cancer (N = 39, 33.6%), the SIR was highest for urinary tract cancer [4.7, 95% CI, 2.42–8.19]. The five year standardized cumulative incidence of cancer was higher for females than for males, and for non-diabetic compared to diabetic causes of ESRD. We estimated that the five year standardized cumulative incidence was highest [8.4, 95% CI, 5.07–13.75] in patients with ESRD, caused by glomerulonephritis.</p><p>Conclusion</p><p>A screening program should be necessary for urinary tract cancer in Korean patients with ESRD. Cancer screening programs for patients with ESRD in Korea should be emphasized on female patients and patients with non-diabetic ESRD.</p></div

Early dialysis initiation does not improve clinical outcomes in elderly end-stage renal disease patients: A multicenter prospective cohort study

<div><p>Background</p><p>The optimal timing for initiating dialysis in end-stage renal disease (ESRD) is controversial, especially in the elderly.</p><p>Methods</p><p>665 patients ≥65 years old who began dialysis from August 2008 to February 2015 were prospectively enrolled in the Clinical Research Center for End-Stage Renal Disease cohort study. Participants were divided into 2 groups based on the median estimated glomerular filtration rate at the initiation of dialysis. Propensity score matching (PSM) was used to compare the overall survival rate, cardiovascular events, Kidney Disease Quality of Life Short Form 36 (KDQOL-36) results, Karnofsky performance scale values, Beck’s depression inventory values, and subjective global assessments.</p><p>Results</p><p>The mean patient age was 72.0 years, and 61.7% of the patients were male. Overall, the cumulative survival rates were lower in the early initiation group, although the difference was not significant after PSM. Additionally, the survival rates of the 2 groups did not differ after adjusting for age, sex, Charlson comorbidity index and hemoglobin, serum albumin, serum calcium and phosphorus levels. Although the early initiation group showed a lower physical component summary score on the KDQOL-36 3 months after dialysis, the difference in scores was not significant 12 months after dialysis. Furthermore, the difference was not significant after PSM. The Karnofsky performance scale, Beck’s depression inventory, and subjective global assessments were not significantly different 3 and 12 months after dialysis initiation.</p><p>Conclusions</p><p>The timing of dialysis initiation is not associated with clinical outcomes in elderly patients with ESRD.</p></div

Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by primary cause of end-stage renal disease.

<p>Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by primary cause of end-stage renal disease.</p

Standard incidence ratios of cancer among ESRD patients by primary site of the cancer, diagnosed between 2009 and 2012.

<p>Standard incidence ratios of cancer among ESRD patients by primary site of the cancer, diagnosed between 2009 and 2012.</p

Standard incidence ratios of cancer among ESRD patients by age, diagnosed between 2009 and 2012.

<p>Standard incidence ratios of cancer among ESRD patients by age, diagnosed between 2009 and 2012.</p

The five-year standardized cumulative incidence ratio controlled for the competing risk for death of any type of cancer.

<p>The five-year standardized cumulative incidence ratio controlled for the competing risk for death of any type of cancer.</p

Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by age at the initiation of dialysis.

<p>Comparison of the standardized cumulative incidence ratio controlling for the competing risk of death from any other cause stratified by age at the initiation of dialysis.</p

Recalibration and Validation of the Charlson Comorbidity Index in Korean Incident Hemodialysis Patients

<div><p>Background</p><p>Weights assigned to comorbidities to predict mortality may vary based on the type of index disease and advances in the management of comorbidities. We aimed to develop a modified Charlson comorbidity index (CCI) in incident hemodialysis patients (mCCI-IHD), thereby improving risk stratification for mortality.</p><p>Methods</p><p>Data on 24,738 Koreans who received their first hemodialysis treatment between 2005 and 2008 were obtained from the Korean Health Insurance dataset. The mCCI-IHD score were calculated by summing up the weights which were assigned to individual comorbidities according to their relative prognostic significance determined by multivariate Cox proportional hazards model. The modified index was validated in an independent nationwide prospective cohort (n=1,100).</p><p>Results</p><p>The Cox proportional hazards model revealed that all comorbidities in the CCI except ulcers significantly predicted mortality. Thus, the mCCI-IHD included 14 comorbidities with re-assigned severity weights. In the validation cohort, both the CCI and the mCCI-IHD were correlated with mortality. However, the mCCI-IHD showed modest but significant increases in <i>c</i> statistics compared with the CCI at 6 months and 1 year. The analyses using continuous net reclassification improvement revealed that the mCCI-IHD improved net mortality risk reclassification by 24.6% (95% CI, 2.5-46.7; <i>P</i>=0.03), 26.2% (95% CI, 1.0-51.4; <i>P</i>=0.04) and 42.8% (95% CI, 4.9-80.8; <i>P</i>=0.03) with respect to the CCI at 6 months and 1 and 2 years, respectively.</p><p>Conclusions</p><p>The mCCI-IHD facilitates better risk stratification for mortality in incident hemodialysis patients compared with the CCI, suggesting that it may be a preferred index for use in clinical practice and the statistical analysis of epidemiological studies.</p></div