Journal Article

Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model

Willem M. van der Wal, Marlies Noordzij, Friedo W. Dekker, Elisabeth W. Boeschoten, Raymond T. Krediet, Johanna C. Korevaar and Ronald B. Geskus

in Nephrology Dialysis Transplantation

Published on behalf of European Renal Association - European Dialysis and Transplant Assoc

Volume 26, issue 9, pages 2978-2983
Published in print September 2011 | ISSN: 0931-0509
Published online February 2011 | e-ISSN: 1460-2385 | DOI: http://dx.doi.org/10.1093/ndt/gfq856
Full loss of residual renal function causes higher mortality in dialysis patients; findings from a marginal structural model

Show Summary Details

Preview

Background. Declining residual renal function, as indicated by the glomerular filtration rate (GFR), is associated with an increased mortality risk in patients with end-stage renal disease (ESRD) on dialysis.

Methods. We monitored GFR and mortality in 1800 haemodialysis (HD) and peritoneal dialysis (PD) patients in 1996–2006. We used a marginal structural model to estimate the causal effects both of GFR when it was not completely lost and of the subsequent full loss of GFR on mortality, avoiding the drawbacks of standard regression models that include covariates to adjust for confounding. Instead, effect estimates were adjusted for possible baseline and time-varying confounders using inverse probability weighting.

Results. We estimated a hazard ratio (HR) corresponding to the effect of the full loss of GFR on mortality, as compared to not having fully lost GFR, of 1.50 [95% confidence interval (CI) 1.09–2.07]. The HR corresponding to the effect of GFR when GFR is not (yet) fully lost on mortality was 0.97 (95% CI 0.92–1.02) (per mL/min/1.73m2). We found no significant difference in the effect of GFR on mortality between patients starting on PD and HD.

Conclusions. Preventing or delaying the full loss of GFR can improve survival in dialysis patients. This supports the importance that is given to the effect of treatment options for patients with ESRD on the rate of decline of the residual renal function.

Keywords: causal modelling; end-stage renal disease; inverse probability weighting; marginal structural model; residual glomerular filtration rate

Journal Article.  3911 words.  Illustrated.

Subjects: Nephrology

Full text: subscription required

How to subscribe Recommend to my Librarian

Users without a subscription are not able to see the full content. Please, subscribe or login to access all content.