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Modelling competing risks in nephrology research: an example in peritoneal dialysis

BACKGROUND: Modelling competing risks is an essential issue in Nephrology Research. In peritoneal dialysis studies, sometimes inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In this situation a com...

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Autores principales: Teixeira, Laetitia, Rodrigues, Anabela, Carvalho, Maria J, Cabrita, António, Mendonça, Denisa
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2013
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664602/
https://www.ncbi.nlm.nih.gov/pubmed/23705871
http://dx.doi.org/10.1186/1471-2369-14-110
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author Teixeira, Laetitia
Rodrigues, Anabela
Carvalho, Maria J
Cabrita, António
Mendonça, Denisa
author_facet Teixeira, Laetitia
Rodrigues, Anabela
Carvalho, Maria J
Cabrita, António
Mendonça, Denisa
author_sort Teixeira, Laetitia
collection PubMed
description BACKGROUND: Modelling competing risks is an essential issue in Nephrology Research. In peritoneal dialysis studies, sometimes inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In this situation a competing risk analysis should be preferable. The objectives of this study are to describe the bias resulting from the application of standard survival analysis to estimate peritonitis-free patient survival and to provide alternative statistical approaches taking competing risks into account. METHODS: The sample comprises patients included in a university hospital peritoneal dialysis program between October 1985 and June 2011 (n = 449). Cumulative incidence function and competing risk regression models based on cause-specific and subdistribution hazards were discussed. RESULTS: The probability of occurrence of the first peritonitis is wrongly overestimated using Kaplan-Meier method. The cause-specific hazard model showed that factors associated with shorter time to first peritonitis were age (≥55 years) and previous treatment (haemodialysis). Taking competing risks into account in the subdistribution hazard model, age remained significant while gender (female) but not previous treatment was identified as a factor associated with a higher probability of first peritonitis event. CONCLUSIONS: In the presence of competing risks outcomes, Kaplan-Meier estimates are biased as they overestimated the probability of the occurrence of an event of interest. Methods which take competing risks into account provide unbiased estimates of cumulative incidence for each specific outcome experienced by patients. Multivariable regression models such as those based on cause-specific hazard and on subdistribution hazard should be used in this competing risk setting.
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spelling pubmed-36646022013-05-28 Modelling competing risks in nephrology research: an example in peritoneal dialysis Teixeira, Laetitia Rodrigues, Anabela Carvalho, Maria J Cabrita, António Mendonça, Denisa BMC Nephrol Research Article BACKGROUND: Modelling competing risks is an essential issue in Nephrology Research. In peritoneal dialysis studies, sometimes inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In this situation a competing risk analysis should be preferable. The objectives of this study are to describe the bias resulting from the application of standard survival analysis to estimate peritonitis-free patient survival and to provide alternative statistical approaches taking competing risks into account. METHODS: The sample comprises patients included in a university hospital peritoneal dialysis program between October 1985 and June 2011 (n = 449). Cumulative incidence function and competing risk regression models based on cause-specific and subdistribution hazards were discussed. RESULTS: The probability of occurrence of the first peritonitis is wrongly overestimated using Kaplan-Meier method. The cause-specific hazard model showed that factors associated with shorter time to first peritonitis were age (≥55 years) and previous treatment (haemodialysis). Taking competing risks into account in the subdistribution hazard model, age remained significant while gender (female) but not previous treatment was identified as a factor associated with a higher probability of first peritonitis event. CONCLUSIONS: In the presence of competing risks outcomes, Kaplan-Meier estimates are biased as they overestimated the probability of the occurrence of an event of interest. Methods which take competing risks into account provide unbiased estimates of cumulative incidence for each specific outcome experienced by patients. Multivariable regression models such as those based on cause-specific hazard and on subdistribution hazard should be used in this competing risk setting. BioMed Central 2013-05-24 /pmc/articles/PMC3664602/ /pubmed/23705871 http://dx.doi.org/10.1186/1471-2369-14-110 Text en Copyright © 2013 Teixeira et al.; licensee BioMed Central Ltd. http://creativecommons.org/licenses/by/2.0 This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
spellingShingle Research Article
Teixeira, Laetitia
Rodrigues, Anabela
Carvalho, Maria J
Cabrita, António
Mendonça, Denisa
Modelling competing risks in nephrology research: an example in peritoneal dialysis
title Modelling competing risks in nephrology research: an example in peritoneal dialysis
title_full Modelling competing risks in nephrology research: an example in peritoneal dialysis
title_fullStr Modelling competing risks in nephrology research: an example in peritoneal dialysis
title_full_unstemmed Modelling competing risks in nephrology research: an example in peritoneal dialysis
title_short Modelling competing risks in nephrology research: an example in peritoneal dialysis
title_sort modelling competing risks in nephrology research: an example in peritoneal dialysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC3664602/
https://www.ncbi.nlm.nih.gov/pubmed/23705871
http://dx.doi.org/10.1186/1471-2369-14-110
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