Comparative Effectiveness of Home Hemodialysis versus Kidney Transplantation in t

描述(由申请人提供)：在50多万患有终末期肾病(ESRD)的美国人中，老年人(65岁以上)的比例继续增加。在1990年、2000年和2010年，39%、44%和44%的普遍透析患者和4%、10%和20%的肾移植接受者是老年人。由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有所上升。肾移植通常被认为是终末期肾病的首选治疗方法，不分年龄。然而，对于老年终末期肾病患者的肾脏替代治疗的最佳选择，目前还没有比较数据，在这些患者中，如夜间和家庭血液透析(HHD)等新型和快速增长的透析方式可能提供与老年最常见的肾脏移植--已故供者移植相同甚至更好的生存优势。以前的数据表明，预计的寿命增加在 与传统透析相比，65-69岁和70-74岁的移植患者分别为2.8年和1.1年。最近的一些研究表明，无论年龄大小，夜间HHD和已故供者移植的调整后存活率没有差异。我们假设，在大多数没有活体供者的等待移植名单的老年ESRD患者中，像HHD这样的当代透析治疗与已故供者移植相比存活率更高，基于人口统计学和其他受者临床和实验室数据的评分系统可以识别这些透析方式或多或少具有优势的老年ESRD患者。在这个项目中，我们将从美国最大的透析供应商之一DaVita那里获得、提炼和连接数据，该公司拥有一个名为移植受者科学注册(SRTR)的国家移植数据库。然后，我们将研究大约1,000名老年(&gt；65岁)HHD患者，他们在2007年1月至2011年12月(5年)期间开始在DaVita诊所接受透析治疗，并将他们的数据与SRTR数据库合并，创建匹配的(1：4)老年身体肾移植患者队列(n=5,000)。我们还将创建一个与活体供肾移植接受者的倾向匹配的队列。此外，我们还将开发和检验一系列预测指标，用于65岁以上终末期肾病患者活体和身体肾移植的选择。我们的评分工具将预测1、3和5年患者和同种异体肾移植的存活率，以及老年人群中移植物丢失的审查死亡率。这一比较有效性研究应用程序将创新性地利用新的方法方法，包括基于倾向性评分的分析，以评估和量化肾移植相对于某些透析方式(包括HHD)的真实有效性。这个为期两年的项目将有效地产生大量关于所选潜在治疗方法的时间敏感信息 对于老年终末期肾病患者来说，这将是直接的临床和

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