Comparative Effectiveness of Home Hemodialysis versus Kidney Transplantation in t

家庭血液透析与肾移植在治疗中的效果比较

• 批准号: 8652787
• 负责人: Kamyar Kalantar-Zadeh
• 金额: $ 19.25万
• 依托单位: UNIVERSITY OF CALIFORNIA-IRVINE
• 依托单位国家: 美国
• 财政年份: 2013
• 资助国家: 美国
• 起止时间: 2013-09-30 至 2015-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8652787
• 关键词: Address; Age; Age-Years; American; Award; California; Cardiovascular Diseases; Clinic; Clinical; Data; Databases; Decision Making; Development; Diabetes Mellitus; Dialysis patients; Dialysis procedure; Effectiveness; Elderly; End stage renal failure; Ethnic Origin; Future; Gender; Hemodialysis; Home Hemodialysis; Immunosuppression; Incidence; Individual; Kidney; Kidney Transplantation; Laboratories; Life; Literature; Living Donors; Longevity; Maintenance; Methodology; Methods; Modality; Modification; Operative Surgical Procedures; Organ Transplantation; Outcome; Patients; Physicians; Population; Postoperative Period; Prevalence; Provider; Race; Randomized Controlled Trials; Registries; Renal Replacement Therapy; Research; Research Project Grants; Risk; Series; Solid; Staging; Survival Analysis; System; Time; Transplant Recipients; Transplantation; Waiting Lists; aged; base; cohort; comparative; comparative effectiveness; design; effectiveness research; human old age (65+); innovation; kidney allograft; mortality; novel; older patient; public health relevance; time interval; tool; transplant database

PROJECT SUMMARY The proportion of the elderly people (e65 years) has continued to increase among over half a million Americans with end-stage renal disease (ESRD). In 1990, 2000 and 2010, 39%, 44% and 44% of all prevalent dialysis patients, and 4%, 10% and 20% of all kidney transplant recipients were elderly. Consequent to the absolute increase of elderly individuals in the population pyramid, the prevalence and incidence of ESRD have also risen. Kidney transplantation is generally regarded as the treatment of choice in ESRD irrespective of age. However, there are no comparative data about the best choice of renal replacement therapy for the elderly ESRD patients, in whom such novel and fast-growing dialysis modalities as nocturnal and home hemodialysis (HHD) may offer same or even better survival advantages than deceased donor transplantation, the most common kidney transplantation in the elderly. Previous data suggest that the projected increases in life spans in transplant patients compared to conventional dialysis were 2.8 and 1.1 years for patients aged 65-69 and 70-74 years, respectively. Some recent studies show no difference in the adjusted survival between nocturnal HHD and deceased donor transplantation irrespective of age. We hypothesize that such contemporary dialysis treatments as HHD are associated with greater survival than deceased donor transplantation in most transplant-wait-listed elderly ESRD patients without a living donor and that a scoring system based on demographic and other recipient clinical and laboratory data can identify those elderly ESRD patients in whom such dialysis modalities are more or less advantageous. In this project, we will obtain, refine, and link data from DaVita, one of the nation's largest dialysis providers, with a national transplant database known as the Scientific Registry of Transplant Recipients (SRTR). We will then study approximately 1,000 elderly (>65 years) incident HHD patients who started dialysis therapy in a DaVita clinic between 1/2007 and 12/2011 (5 years) and after merging their data with the SRTR database to create a propensity score matched (1:4) cohort of elderly cadaveric kidney transplant recipient (n=5,000). We will also create a propensity-matched cohort with living donor kidney transplant recipient. In addition, we will develop and examine a series of predictor scores for selection of living and cadaveric kidney transplantation in ESRD recipient over 65 years of age. Our scoring tools will predict the 1-, 3- and 5-year patient and kidney allograft survival as well as graft-loss censored mortality in the elderly population. This comparative effectiveness research proposal will innovatively utilize new methodological approaches including propensity score based analyses to assess and to quantify the true effectiveness of kidney transplantation versus certain dialysis modalities including HHD. This 2-year project will efficiently generate a wealth of time-sensitive information about the potential treatment of choice in elderly ESRD patients that will be of immediate clinical and public health relevance and inform decision making by physicians, patients, providers, and payers.

项目摘要 在50多万人口中，老年人（65岁以上）的比例继续增加， 终末期肾病（ESRD）的美国人。在1990年、2000年和2010年，39%、44%和 透析患者，4%，10%和20%的所有肾移植受者是老年人。因应本公司于 人口金字塔中老年人的绝对增加，ESRD的患病率和发病率 也上升了。肾移植通常被认为是治疗终末期肾病的首选，与年龄无关。 但是，关于老年人肾脏替代治疗的最佳选择，目前还没有比较数据 ESRD患者，夜间和家庭血液透析等新型且快速发展的透析方式 (HHD)可能提供相同或更好的生存优势比死者供体移植，最 老年人常见的肾移植。以前的数据表明，预期寿命的增加 与传统透析相比，65-69岁患者的移植患者分别为2.8年和1.1年， 分别为70-74岁。最近的一些研究表明，夜间睡眠与夜间睡眠之间的校正生存率没有差异。 HHD和死亡供体移植，不考虑年龄。我们假设这种当代透析 在大多数情况下，HHD治疗与死亡供体移植相比， 没有活体供体的等待移植的老年ESRD患者，评分系统基于 人口统计学和其他接受者临床和实验室数据可以确定那些老年ESRD患者， 这样的透析方式或多或少是有利的。在本项目中，我们将从以下方面获取、提炼和链接数据： DaVita是美国最大的透析提供商之一，拥有一个全国移植数据库， 移植受体科学登记处（SRTR）。然后我们将研究大约1，000名老年人（>65岁 在2007年1月至2011年12月期间在DaVita诊所开始透析治疗的20例（5岁）HHD患者 年），并将其数据与SRTR数据库合并以创建倾向评分匹配（1：4）队列后 老年尸体肾移植受者（n= 5，000）。我们还将创建一个倾向匹配的队列， 活体肾脏移植受体此外，我们将开发和检查一系列的预测分数 供65岁以上终末期肾病患者选择活体和尸体肾移植。我们的评分 工具将预测1年、3年和5年患者和肾移植物存活率以及移植物丢失删失 老年人口的死亡率。这一比较有效性研究提案将创新性地利用 新的方法学方法，包括基于倾向分数的分析，以评估和量化真实的 肾移植与某些透析方式（包括HHD）的有效性。这个为期2年的项目将 有效地生成大量关于老年人潜在治疗选择的时间敏感信息 ESRD患者将具有直接的临床和公共卫生相关性，并通过以下方式告知决策 医生、患者、供应商和付款人。