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.

项目概要 超过50万的老年人口（e65岁）比例持续增加 患有终末期肾病（ESRD）的美国人。 1990 年、2000 年和 2010 年，占所有流行病的 39%、44% 和 44% 透析患者中​​，所有肾移植接受者中分别有 4%、10% 和 20% 是老年人。结果是 人口金字塔中老年人绝对数增加，ESRD患病率和发病率呈上升趋势 也上涨了。肾移植通常被认为是 ESRD 的首选治疗方法，无论年龄如何。 但对于老年人肾脏替代治疗的最佳选择尚无比较数据 ESRD 患者，其中夜间和家庭血液透析等新型且快速增长的透析方式 (HHD) 可能比死者供体移植提供相同甚至更好的生存优势，这是最 老年人常见肾移植。先前的数据表明，预计寿命会延长 与传统透析相比，移植患者的 65-69 岁患者的治疗时间分别为 2.8 年和 1.1 年 分别是70-74岁。最近的一些研究表明，夜间活动者的调整生存率没有差异。 HHD 和已故供体移植，无论年龄。我们假设这种当代透析 在大多数情况下，HHD 治疗比死者供体移植的存活率更高 移植等待名单上没有活体捐赠者的老年 ESRD 患者，以及基于 人口统计和其他接受者临床和实验室数据可以识别那些老年终末期肾病患者 这种透析方式或多或少是有利的。在这个项目中，我们将从以下位置获取、提炼和链接数据 DaVita 是美国最大的透析提供商之一，拥有一个名为“移植数据库”的国家移植数据库 移植受者科学登记处 (SRTR)。然后我们将研究大约 1,000 名老年人（>65 年）事件 HHD 患者在 2007 年 1 月至 2011 年 12 月期间在 DaVita 诊所开始透析治疗（5 年）并将他们的数据与 SRTR 数据库合并以创建倾向得分匹配 (1:4) 队列 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 活体肾移植受者。此外，我们将开发和检查一系列预测分数 用于选择 65 岁以上 ESRD 受者的活体肾移植和尸体肾移植。我们的得分 工具将预测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情况 老年人口的死亡率。这项比较有效性研究提案将创新地利用 新的方法论方法，包括基于倾向评分的分析，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 有效地生成大量有关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，并通过以下方式为决策提供信息 医生、患者、提供者和付款人。