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Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study

BACKGROUND: Patients with chronic kidney diseases (CKD) on haemodialysis (HD) have high morbidity and mortality rates, which are also due to the inherent risks associated with nephropathy. Non-adherence (NA) to the different demands of the treatment can have consequences for the outcome of patients...

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Autores principales: Dantas, Lianna G. G., de Seixas Rocha, Mário, Junior, José Andrade Moura, Paschoalin, Edson Luiz, Paschoalin, Sandra R. K. P., Sampaio Cruz, Constança M.
Formato: Online Artículo Texto
Lenguaje:English
Publicado: BioMed Central 2019
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836324/
https://www.ncbi.nlm.nih.gov/pubmed/31694560
http://dx.doi.org/10.1186/s12882-019-1573-x
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author Dantas, Lianna G. G.
de Seixas Rocha, Mário
Junior, José Andrade Moura
Paschoalin, Edson Luiz
Paschoalin, Sandra R. K. P.
Sampaio Cruz, Constança M.
author_facet Dantas, Lianna G. G.
de Seixas Rocha, Mário
Junior, José Andrade Moura
Paschoalin, Edson Luiz
Paschoalin, Sandra R. K. P.
Sampaio Cruz, Constança M.
author_sort Dantas, Lianna G. G.
collection PubMed
description BACKGROUND: Patients with chronic kidney diseases (CKD) on haemodialysis (HD) have high morbidity and mortality rates, which are also due to the inherent risks associated with nephropathy. Non-adherence (NA) to the different demands of the treatment can have consequences for the outcome of patients undergoing HD; nevertheless, there are still doubts about such repercussions. This study was conducted to evaluate the association between NA to conventional HD and all-cause mortality and cardiovascular mortality. METHODS: We prospectively evaluated mortality in a 6-year period in a cohort of 255 patients on HD in northeast Brazil. The evaluated parameters of NA to HD were interdialytic weight gain (IDWG) ≥ 4% of dry weight (DW), hyperphosphatemia and regular attendance at treatment, assessed as the correlation between the periods on HD completed and those prescribed. We used the Cox multivariate regression model to analyse survival and the predictors of all-cause mortality and cardiovascular mortality. RESULTS: With a median follow-up period of 1493 days and a mortality rate of 9.1 per 100 people-years, there were 87 deaths, of which 54% were cardiovascular deaths. IDWG ≥4% of DW was associated with a risk of all-cause mortality however presenting a borderline outcome for cardiovascular mortality, with hazard ratios of 2.02 (CI 95% 1.17–3.49, p = 0.012) and 2.09 (CI 95% 1.01–4.35, p = 0.047), respectively. No significant association was found between other parameters of NA and mortality. Subgroup analysis showed that for patients with IDWG ≥4% of DW, malnutrition, age and diagnosis of cardiovascular and cerebrovascular diseases were associated with higher all-cause mortality. CONCLUSIONS: IDWG ≥4% of DW was identified as an independent predictor of all-cause mortality and demonstrated a borderline outcome for cardiovascular mortality in patients on conventional HD. The occurrence of excessive IDWG in the presence of malnutrition represented a significant increase in the risk of death, indicating a subgroup of patients with a worse prognosis.
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spelling pubmed-68363242019-11-08 Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study Dantas, Lianna G. G. de Seixas Rocha, Mário Junior, José Andrade Moura Paschoalin, Edson Luiz Paschoalin, Sandra R. K. P. Sampaio Cruz, Constança M. BMC Nephrol Research Article BACKGROUND: Patients with chronic kidney diseases (CKD) on haemodialysis (HD) have high morbidity and mortality rates, which are also due to the inherent risks associated with nephropathy. Non-adherence (NA) to the different demands of the treatment can have consequences for the outcome of patients undergoing HD; nevertheless, there are still doubts about such repercussions. This study was conducted to evaluate the association between NA to conventional HD and all-cause mortality and cardiovascular mortality. METHODS: We prospectively evaluated mortality in a 6-year period in a cohort of 255 patients on HD in northeast Brazil. The evaluated parameters of NA to HD were interdialytic weight gain (IDWG) ≥ 4% of dry weight (DW), hyperphosphatemia and regular attendance at treatment, assessed as the correlation between the periods on HD completed and those prescribed. We used the Cox multivariate regression model to analyse survival and the predictors of all-cause mortality and cardiovascular mortality. RESULTS: With a median follow-up period of 1493 days and a mortality rate of 9.1 per 100 people-years, there were 87 deaths, of which 54% were cardiovascular deaths. IDWG ≥4% of DW was associated with a risk of all-cause mortality however presenting a borderline outcome for cardiovascular mortality, with hazard ratios of 2.02 (CI 95% 1.17–3.49, p = 0.012) and 2.09 (CI 95% 1.01–4.35, p = 0.047), respectively. No significant association was found between other parameters of NA and mortality. Subgroup analysis showed that for patients with IDWG ≥4% of DW, malnutrition, age and diagnosis of cardiovascular and cerebrovascular diseases were associated with higher all-cause mortality. CONCLUSIONS: IDWG ≥4% of DW was identified as an independent predictor of all-cause mortality and demonstrated a borderline outcome for cardiovascular mortality in patients on conventional HD. The occurrence of excessive IDWG in the presence of malnutrition represented a significant increase in the risk of death, indicating a subgroup of patients with a worse prognosis. BioMed Central 2019-11-06 /pmc/articles/PMC6836324/ /pubmed/31694560 http://dx.doi.org/10.1186/s12882-019-1573-x Text en © The Author(s). 2019 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
Dantas, Lianna G. G.
de Seixas Rocha, Mário
Junior, José Andrade Moura
Paschoalin, Edson Luiz
Paschoalin, Sandra R. K. P.
Sampaio Cruz, Constança M.
Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title_full Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title_fullStr Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title_full_unstemmed Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title_short Non-adherence to Haemodialysis, Interdialytic weight gain and cardiovascular mortality: a cohort study
title_sort non-adherence to haemodialysis, interdialytic weight gain and cardiovascular mortality: a cohort study
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC6836324/
https://www.ncbi.nlm.nih.gov/pubmed/31694560
http://dx.doi.org/10.1186/s12882-019-1573-x
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