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Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis

BACKGROUND: Illicit drug use is common and known to cause and exacerbate a wide spectrum of kidney disease, often leading to end-stage renal disease (ESRD), but little is known about its prevalence or associated mortality among incident hemodialysis patients. METHODS: This study is a retrospective c...

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Autores principales: Grubbs, Vanessa, Vittighoff, Eric, Grimes, Barbara, Johansen, Kirsten L.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2016
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898454/
https://www.ncbi.nlm.nih.gov/pubmed/27278934
http://dx.doi.org/10.1186/s12882-016-0271-1
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author Grubbs, Vanessa
Vittighoff, Eric
Grimes, Barbara
Johansen, Kirsten L.
author_facet Grubbs, Vanessa
Vittighoff, Eric
Grimes, Barbara
Johansen, Kirsten L.
author_sort Grubbs, Vanessa
collection PubMed
description BACKGROUND: Illicit drug use is common and known to cause and exacerbate a wide spectrum of kidney disease, often leading to end-stage renal disease (ESRD), but little is known about its prevalence or associated mortality among incident hemodialysis patients. METHODS: This study is a retrospective cohort analysis using data obtained from the United States Renal Data System. We assembled a cohort of 511,821 incident hemodialysis patients age 20 years and older who initiated hemodialysis between January 1, 2006 and December 31, 2010. Illicit drug dependence was defined by comorbidity on the ESRD Medical Evidence Report (Form CMS-2728). We performed survival analysis to examine the association of drug dependence with overall mortality and mortality due to diagnoses that can be associated with intravenous drug use (drug-sensitive diagnoses) in the first year after initiating hemodialysis. RESULTS: Drug dependence was recorded for 1.5 % (n = 7,461). Drug dependence was independently associated with a 1.3-fold and 2.5-fold higher hazard of overall mortality and mortality due to a potentially drug-sensitive diagnosis [adjusted hazard ratio (AHR) 1.34 (1.27–1.41) and 2.54 (2.05–3.14), p < 0.001, respectively]. This association varied significantly by age (p(interaction) < 0.001), with a 9-fold higher hazard of mortality due to a potentially drug-sensitive diagnosis among the youngest patients with drug dependence [AHR 9.21 (5.15–16.44), p < 0.001]. CONCLUSION: Illicit drug dependence is a burden within the ESRD program and is strongly associated with premature mortality, particularly among younger patients. Targeted intervention is needed to help reduce this burden. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0271-1) contains supplementary material, which is available to authorized users.
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spelling pubmed-48984542016-06-09 Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis Grubbs, Vanessa Vittighoff, Eric Grimes, Barbara Johansen, Kirsten L. BMC Nephrol Research Article BACKGROUND: Illicit drug use is common and known to cause and exacerbate a wide spectrum of kidney disease, often leading to end-stage renal disease (ESRD), but little is known about its prevalence or associated mortality among incident hemodialysis patients. METHODS: This study is a retrospective cohort analysis using data obtained from the United States Renal Data System. We assembled a cohort of 511,821 incident hemodialysis patients age 20 years and older who initiated hemodialysis between January 1, 2006 and December 31, 2010. Illicit drug dependence was defined by comorbidity on the ESRD Medical Evidence Report (Form CMS-2728). We performed survival analysis to examine the association of drug dependence with overall mortality and mortality due to diagnoses that can be associated with intravenous drug use (drug-sensitive diagnoses) in the first year after initiating hemodialysis. RESULTS: Drug dependence was recorded for 1.5 % (n = 7,461). Drug dependence was independently associated with a 1.3-fold and 2.5-fold higher hazard of overall mortality and mortality due to a potentially drug-sensitive diagnosis [adjusted hazard ratio (AHR) 1.34 (1.27–1.41) and 2.54 (2.05–3.14), p < 0.001, respectively]. This association varied significantly by age (p(interaction) < 0.001), with a 9-fold higher hazard of mortality due to a potentially drug-sensitive diagnosis among the youngest patients with drug dependence [AHR 9.21 (5.15–16.44), p < 0.001]. CONCLUSION: Illicit drug dependence is a burden within the ESRD program and is strongly associated with premature mortality, particularly among younger patients. Targeted intervention is needed to help reduce this burden. ELECTRONIC SUPPLEMENTARY MATERIAL: The online version of this article (doi:10.1186/s12882-016-0271-1) contains supplementary material, which is available to authorized users. BioMed Central 2016-06-08 /pmc/articles/PMC4898454/ /pubmed/27278934 http://dx.doi.org/10.1186/s12882-016-0271-1 Text en © The Author(s). 2016 Open AccessThis article is distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided you give appropriate credit to the original author(s) and the source, provide a link to the Creative Commons license, and indicate if changes were made. The Creative Commons Public Domain Dedication waiver (http://creativecommons.org/publicdomain/zero/1.0/) applies to the data made available in this article, unless otherwise stated.
spellingShingle Research Article
Grubbs, Vanessa
Vittighoff, Eric
Grimes, Barbara
Johansen, Kirsten L.
Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title_full Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title_fullStr Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title_full_unstemmed Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title_short Mortality and illicit drug dependence among hemodialysis patients in the United States: a retrospective cohort analysis
title_sort mortality and illicit drug dependence among hemodialysis patients in the united states: a retrospective cohort analysis
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4898454/
https://www.ncbi.nlm.nih.gov/pubmed/27278934
http://dx.doi.org/10.1186/s12882-016-0271-1
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