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

基本信息

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
项目类别：
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

项目摘要

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）：在超过半百万的患有末期肾脏疾病（ESRD）的美国人中，老年人的比例（超过65年）继续增加。在1990年，2000年和2010年，所有流行透析患者的39％，44％和44％，所有肾脏移植受者的4％，10％和20％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增加了。无论年龄如何，肾脏移植通常被视为ESRD选择的治疗方法。但是，没有关于老年ESRD患者肾脏替代疗法的最佳选择的比较数据，在这些患者中，夜间和家庭血液透析（HHD）等新颖而快速增长的透析方式（HHD）的生存率可能比已故捐赠者移植，最常见的肾脏移植，是老年老年人的最常见的肾脏移植。先前的数据表明，预计的生命跨度增加与常规透析相比，65-69岁和70-74岁患者的移植患者分别为2.8和1.1岁。最近的一些研究表明，夜间HHD和已故供体移植之间的调整后存活率无差异。我们假设在大多数没有活体供体的人口供体的老年人列入的老年人ESRD患者中，这种当代透析治疗与死者的供体移植相比，与已故的供体移植相比，与死者的捐助者移植更大，并且基于人口统计学和其他受体临床和实验室数据的评分系统可以识别出这些diasies diasiS iparlysis Modals有害的老年ESRD患者。在这个项目中，我们将获得美国最大的透析提供者之一达维塔（Davita）的数据，并拥有一个名为“移植受体科学注册”（SRTR）的国家移植数据库。然后，我们将研究大约1,000名老年人（> 65年）事件的HHD患者，他们在1/2007至12/2011（5年）之间在Davita诊所开始透析治疗，并在将数据与SRTR数据库合并后，以创建与SRTR数据库相匹配（1：4）老年cadaveric cadaveric cadaveric cadaveric cadaveric kidneic kidney kidney transney transplantplant受众（n = 5,000）。我们还将与活着的供体肾脏移植受者创建一个倾向匹配的队列。此外，我们将开发并检查一系列预测因子得分，以选择65岁以上的ESRD接受者的生活和尸体肾脏移植。我们的评分工具将预测老年人群中的1岁，3年和5年患者和肾脏同种异体移植生存以及移植损失的死亡率。这种比较有效性的研究应用将创新地利用新的方法论方法，包括基于倾向得分的分析，以评估和量化肾脏移植的真实有效性与某些透析模态在内，包括HHD。这个为期两年的项目将有效地产生有关选择潜在处理的大量时间敏感信息在老年ESRD患者中，将立即进行临床和