Resumen de Initial Glomerular Filtration Rate and Survival in Hemodialysis: The role of permanent vascular access

S. Marinovich, Jaime Pérez Loredo, Carlos Lavorato, Guillermo Javier Rosa Díez, Liliana Bisigniano, Víctor Fernández, Daniela Hansen Krogh

• A significant increase in the number of patients starting chronic hemodialysis (HD) with an estimated glomeru - lar filtration rate (eGFR) > 10mL/min/1.73m 2 was observed in Ar - gentina between 2004 and 2009.

  Methods:

  In order to study this topic, we calculated the mortality hazard ratios (HR) in a cohort of incident HD individuals from the Argentine Regis - try of Chronic Dialysis [Registro Argentino de Diálisis Crónica] (2004-2009), grouped according to the initial eGFR (0-4.9, 5-9.9, 10-14.9 and > 15mL/min/1.73m 2 ; reference group 0-4.9) estima - ted by CKD-EPI; in three cohorts: �total population�, �healthy (<65 years, without diabetes or comorbidities) and �planned entry� (with permanent vascular access).

  Results:

  After adjus - ting the population (n=16,931) for age, gender, coexisting con - ditions, serum albumin, income, and temporary vascular access a HR of 1.19 (95%CI:1.07-1.33) was observed in the group with eGFR > 15mL/min/1.73m 2 . In the cohort of 3,897 �healthy� after adjusting for the same co-variates, HRs of 1.44(95%CI:1.08-1.65) and 1.65(95%CI:1.06-2.55) were obtained for the groups with baseline eGFR values of 10-14.9 and > 15mL/min/1.73m 2 , respec - tively. In �planned entry� patients (n=6,280), after adjusting for age, gender, co-morbidities, serum albumin and income, HRs in all groups were not significantly different as compared to the control group. HD initiation with eGFR>10mL/ min/1.73m 2 shows no survival advantage. The higher mortality in the group with >eGFR starting dialysis looks like an �artifact� related to higher age, more co-morbidities, low albuminemia and the use of temporary vascular access