Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients

Gregory Gorman, Susan Furth, Wenke Hwang, Rulan Parekh, Brad Astor, Barbara Fivush, Diane Frankenfield, Alicia Neu

Research output: Contribution to journalArticle

18 Citations (Scopus)

Abstract

• Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKt/V) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKt/V was analyzed by the adult target (< versus <1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKt/V less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fail to attain an spKt/V of 1.2 or greater. However, attaining an spKt/V in excess of 1.4 was not associated with greater benefit.

Original languageEnglish (US)
Pages (from-to)285-293
Number of pages9
JournalAmerican Journal of Kidney Diseases
Volume47
Issue number2
DOIs
StatePublished - Feb 1 2006

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Renal Dialysis
Dialysis
Hospitalization
Guidelines
Confidence Intervals
Kidney
Risk Adjustment
Kidney Diseases
Information Systems
Chronic Kidney Failure
Albumins
Hemoglobins
Mortality
Therapeutics

All Science Journal Classification (ASJC) codes

  • Nephrology

Cite this

Gorman, Gregory ; Furth, Susan ; Hwang, Wenke ; Parekh, Rulan ; Astor, Brad ; Fivush, Barbara ; Frankenfield, Diane ; Neu, Alicia. / Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients. In: American Journal of Kidney Diseases. 2006 ; Vol. 47, No. 2. pp. 285-293.
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abstract = "• Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKt/V) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKt/V was analyzed by the adult target (< versus <1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKt/V less than 1.2 had increased hospitalization risk (1.59; 95{\%} confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95{\%} confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fail to attain an spKt/V of 1.2 or greater. However, attaining an spKt/V in excess of 1.4 was not associated with greater benefit.",
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Gorman, G, Furth, S, Hwang, W, Parekh, R, Astor, B, Fivush, B, Frankenfield, D & Neu, A 2006, 'Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients', American Journal of Kidney Diseases, vol. 47, no. 2, pp. 285-293. https://doi.org/10.1053/j.ajkd.2005.10.020

Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients. / Gorman, Gregory; Furth, Susan; Hwang, Wenke; Parekh, Rulan; Astor, Brad; Fivush, Barbara; Frankenfield, Diane; Neu, Alicia.

In: American Journal of Kidney Diseases, Vol. 47, No. 2, 01.02.2006, p. 285-293.

Research output: Contribution to journalArticle

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T1 - Clinical outcomes and dialysis adequacy in adolescent hemodialysis patients

AU - Gorman, Gregory

AU - Furth, Susan

AU - Hwang, Wenke

AU - Parekh, Rulan

AU - Astor, Brad

AU - Fivush, Barbara

AU - Frankenfield, Diane

AU - Neu, Alicia

PY - 2006/2/1

Y1 - 2006/2/1

N2 - • Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKt/V) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKt/V was analyzed by the adult target (< versus <1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKt/V less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fail to attain an spKt/V of 1.2 or greater. However, attaining an spKt/V in excess of 1.4 was not associated with greater benefit.

AB - • Background: The National Kidney Foundation-Kidney Disease Outcomes Quality Initiative guidelines recommend that adult hemodialysis (HD) patients receive a minimum dialysis dose by single-pooled Kt/V (spKt/V) of 1.2 or greater. There are no data to support a minimum spKt/V dose for children on HD therapy. We aim to determine the association of spKt/V with mortality and hospitalization in adolescents. Methods: Clinical characteristics of adolescent HD patients aged 12 to 18 years old included in the 2000/2001 End-Stage Renal Disease Clinical Performance Measures Project were linked to US Renal Data System data from October 1, 1999, to October 15, 2001. Hospitalization risks after adjustment for time on dialysis therapy, access, hemoglobin level, albumin level, and height were determined by means of Poisson regression. spKt/V was analyzed by the adult target (< versus <1.2) and by intervals. Results: There were 613 patients with 477 patient-years of follow-up, during which there were 14 deaths and 185 hospitalizations covering 1,108 days. After adjustment, patients with an spKt/V less than 1.2 had increased hospitalization risk (1.59; 95% confidence interval, 0.98 to 2.56; P = 0.06) compared with those with an spKt/V of 1.2 or greater. Compared with patients with an spKt/V of 1.2 to 1.4, patients with an spKt/V less than 1.2 had increased adjusted risk for hospitalization (2.46; 95% confidence interval, 1.23 to 4.94; P = 0.01). Increases in spKt/V beyond 1.4 were not associated with improved outcomes. Conclusion: Applying the current adequacy guideline to adolescent HD patients is justified by the increased hospitalization risk of those who fail to attain an spKt/V of 1.2 or greater. However, attaining an spKt/V in excess of 1.4 was not associated with greater benefit.

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