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- Title
Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout.
- Authors
Misra, Madhukar; Vonesh, Ed; Churchill, David N.; Moore, Harold L.; Van Stone, John C.; Nolph, Karl D.
- Abstract
Preservation of glomerular filtration rate on dialysis when adjusted for patient dropout. Background. Residual renal function (RRF) plays an important role in dialysis patients. Studies in patients on maintenance dialysis suggest that RRF is better preserved in patients receiving peritoneal dialysis (PD) vis-à-vis those receiving hemodialysis (HD). We speculated that regardless of the patient's type of therapy, the estimate obtained for the rate of decline in glomerular filtration rate (GFR) may be biased because of informative censoring associated with patient dropout. Informative censoring occurs when patients who die or transfer to another modality very early have associated with them a lower starting GFR or a higher rate of decline of GFR than patients who either complete the study or who die or transfer much later. If patient dropout is indeed related to the rate of decline in GFR and if this relationship is ignored in the analysis, then the estimate obtained of the rate of decline in GFR may be biased. Methods. In an attempt to determine if there is a relationship between patient dropout and the decline in GFR, we reanalyzed the CANUSA data by modeling GFR as a nonlinear function of time with the rate of decline being exponential. Results. This article highlights the significance of “informative censoring” when studying the decline of RRF on dialysis. The results show that for the CANUSA cohort, the mean initial GFR was significantly lower, and the rate of decline was significantly higher for patients who died or transferred to HD than for patients who were randomly censored or received a transplant. It is important to emphasize that the impact of informative censoring on previous analyses of the decline of RRF between PD versus HD is presently unclear. If bias caused by informative censoring is the same regardless of what therapy a patient is on, then conclusions from previous studies comparing the decline in GFR between PD and HD would...
- Subjects
PERITONEAL dialysis; GLOMERULAR filtration rate; PATIENTS
- Publication
Kidney International, 2000, Vol 57, Issue 2, p691
- ISSN
0085-2538
- Publication type
Article
- DOI
10.1046/j.1523-1755.2000.00891.x