Preoperative Dialysis Dose and Postoperative Outcomes in Patients Receiving Maintenance Hemodialysis
Notice bibliographique
Résumé
Key Points Little is known about preoperative hemodialysis dosing for patients with ESKD. Among patients receiving maintenance hemodialysis, preoperative decreases in Kt/V urea were significantly associated with postoperative mortality. The connection between preoperative hemodialysis practices and postoperative outcomes warrants further investigation. Background Little is known about preoperative hemodialysis dosing for patients with ESKD. We assessed whether changes in preoperative hemodialysis dose (compared with and controlling for baseline dose) are associated with postoperative mortality in patients receiving maintenance hemodialysis. Methods We identified fee-for-service Medicare beneficiaries receiving hemodialysis for ESKD who underwent surgical procedures between January 1, 2011, and November 30, 2020. Follow-up ended December 31, 2020. The primary exposure was preoperative change in Kt/V urea , defined as the difference between the Kt/V urea in the hemodialysis session proximal to the procedure and the mean Kt/V urea for the preceding 180 days. The primary outcome was postoperative 30-day mortality. The relation between preoperative change in Kt/V urea and the primary outcome was modeled using a Cox proportional hazards regression model, adjusted for mean and SD of Kt/V urea in the 180 days preceding the procedure, and for other covariates. Results Among 151,240 procedures (median age, 65 years [25%–75% range, 56–73], 63,437 [41.9%] in women), 31,825 (21.0%) had a preoperative change in Kt/V urea of <−0.10, 43,790 (29.0%) had a preoperative change of −0.10 to <0, 45,058 (29.8%) had a preoperative change of 0 to <+0.10, and 30,567 (20.2%) had a preoperative change of ≥+0.10. The median Kt/V urea for the 180 days before the procedure was 1.58 (25th–75th percentiles, 1.45–1.74). In adjusted analysis, compared with patients with a preoperative change in Kt/V urea of 0 to <+0.10, 30-day mortality was 1.50 (95% confidence interval, 1.32 to 1.70) times higher with a preoperative Kt/V urea change of ≤−0.10 and 1.16 (95% confidence interval, 1.02 to 1.31) times higher with a preoperative Kt/V urea change of −0.10 to <0. Increases in preoperative Kt/V urea that were >0.10 were not significantly associated with 30-day mortality. Conclusions Among Medicare beneficiaries receiving maintenance hemodialysis, preoperative decreases in Kt/V urea (compared with and controlling for mean Kt/V urea ) were significantly associated with postoperative mortality.
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Comment cette classification a été obtenuedéplier
Prédiction distillée sur la base complète
Imitation des enseignantsNi prévalence calibrée, ni vérité terrain. Validation humaine à venir. Apprise à partir de 10 348 étiquettes directes de Codex et de 10 348 étiquettes directes de Gemma. Le mode candidate est l'union des têtes enseignantes seuillées; le consensus est leur intersection. Ces sorties portent le statut machine_predicted_unvalidated et ne sont ni des étiquettes humaines ni des étiquettes directes de modèles de pointe.
Scores Codex et Gemma par catégorie
| Catégorie | Codex | Gemma |
|---|---|---|
| Métarecherche | 0,000 | 0,002 |
| Méta-épidémiologie (sens strict) | 0,000 | 0,000 |
| Méta-épidémiologie (sens large) | 0,001 | 0,000 |
| Bibliométrie | 0,000 | 0,001 |
| Études des sciences et des technologies | 0,000 | 0,000 |
| Communication savante | 0,000 | 0,000 |
| Science ouverte | 0,000 | 0,000 |
| Intégrité de la recherche | 0,000 | 0,000 |
| Charge utile insuffisante (le modèle a refusé de juger) | 0,000 | 0,000 |
Scores machine (provisoires)
Les deux têtes enseignantes du modèle étudiant, lues sur ce travail. Un score ordonne la base pour la relecture; il n'affirme jamais une catégorie, et le statut de validation accompagne chaque rangée tel quel.
Scores de référence d'un modèle non mature (critères de maturité non atteints, 7 itérations). Un score ordonne; il n'affirme jamais une catégorie.
score_only:v0-immature-baseline · tel quel depuis la passe de notation : score_only signifie que le nombre peut ordonner les travaux, et qu'aucune étiquette de catégorie n'en découleClassification
machine, non validéePrédiction automatique; un appel candidat d’une seule tête enseignante, pas un consensus.
Le détail, modèle par modèle et score par score, se trouve en fin de page sous « Comment cette classification a été obtenue ».