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: 8741928
• 负责人: Kamyar Kalantar-Zadeh
• 金额: $ 23.18万
• 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 2017-06-30
• 项目状态: 已结题
• 来源: https://reporter.nih.gov/project-details/8741928
• 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

DESCRIPTION (provided by applicant): The proportion of the elderly people (over 65 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 lin 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 application 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

描述（由申请人提供）：在超过 50 万患有终末期肾病 (ESRD) 的美国人中，老年人（65 岁以上）的比例持续增加。 1990年、2000年和2010年，所有流行透析患者中​​分别有39%、44%和44%，以及所有肾移植受者中4%、10%和20%是老年人。由于人口金字塔中老年人的绝对数量增加，ESRD的患病率和发病率也随之上升。肾移植通常被认为是 ESRD 的首选治疗方法，无论年龄如何。然而，目前还没有关于老年终末期肾病患者最佳肾脏替代治疗选择的比较数据，夜间和家庭血液透析（HHD）等新型且快速增长的透析方式可能比死亡供体移植（老年人最常见的肾移植）提供相同甚至更好的生存优势。先前的数据表明，预计寿命将延长 与传统透析相比，65-69 岁和 70-74 岁患者的移植时间分别为 2.8 和 1.1 年。最近的一些研究表明，无论年龄如何，夜间 HHD 和已故供体移植之间的调整后生存率没有差异。我们假设，对于大多数等待移植但没有活体捐赠者的老年 ESRD 患者来说，HHD 等现代透析治疗比已故捐赠者移植具有更高的生存率，并且基于人口统计和其他受者临床和实验室数据的评分系统可以识别出此类透析方式或多或少有利的老年 ESRD 患者。在这个项目中，我们将从 DaVita（美国最大的透析提供商之一）获取、完善和链接数据，该数据库拥有一个称为移植受者科学登记处 (SRTR) 的国家移植数据库。然后，我们将研究大约 1,000 名在 DaVita 诊所于 2007 年 1 月至 12/2011（5 年）期间开始透析治疗的老年（> 65 岁）突发 HHD 患者，并将他们的数据与 SRTR 数据库合并，创建一个倾向评分匹配（1:4）的老年尸体肾移植受者队列（n=5,000）。我们还将创建一个与活体肾移植受者倾向匹配的队列。此外，我们将开发和检查一系列预测评分，用于选择 65 岁以上 ESRD 受者的活体肾移植和尸体肾移植。我们的评分工具将预测老年人群中患者和肾同种异体移植物的 1 年、3 年和 5 年存活率以及移植物丢失审查死亡率。这项比较有效性研究应用将创新性地利用新的方法学方法，包括基于倾向评分的分析，以评估和量化肾移植相对于包括 HHD 在内的某些透析方式的真实有效性。这个为期 2 年的项目将有效地生成大量有关潜在治疗选择的时间敏感信息 老年终末期肾病 (ESRD) 患者将立即获得临床和