演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Effects of Residual Renal Function and Comorbidity on Long-Term and Short-Term Outcome in Japanese Dialysis Patients

演題番号 : GI-8-3

Kunihiro Yamagata:1

1:Department of Nephrology, Graduate School of Comprehensive Human Sciences, University of Tsukuba

 

JSDT have conducted incident dialysis patient surveys in 1989-1990 and in 2006- 2007. We analyzed the effects of residual renal function at the start of RRT, duration of nephrology care, and comorbidity on both cohorts. The subjects of incident cohort in 1989-1990 were 20,854 patients (mean age; 57.7 years, 59.4% of the subjects were male, and 28.7% had diabetes, mean eGFR at dialysis initiation was 5.00 ml/minute/1.73 m2) and the subjects in 2007 incident cohort were 9,770 patients (average age; 67.5 years, 64.3% of the subjects were male, and 42.8% had diabetes, mean eGFR at dialysis initiation was 6.55 ml/min/1.73 m2). From the incident cohort in 1989-1990, the higher eGFR at dialysis initiation, the worse the odds ratio (OR) of the survival risk in both short-term and long-term prognoses by unadjusted analysis. However, the long-term unfavorable effect diminished after adjustments for age, PRD, gender, and comorbidity. From the incident cohort in 2007, after adjustment for age, gender, PRD, and comorbidity, not only the group with eGFR >6 ml/min/1.73 m2 but also that with eGFR<2 ml/min/1.73 m2 showed a significant OR of survival risk increment (OR, 3.37; 95%CI: 1.15-9.88).From these studies, long-term exposure of uremic toxins before dialysis initiation did not affect long-term prognosis. Patients with not only early initiation of dialysis but also very late initiation of dialysis showed poor survival. ESRD patients should receive nephrology care for more than 6 months and initiate dialysis therapy before their GFR reaches 2 ml/min/1.73 m2.

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