Lack of Association between Dialysis Modality and Outcomes in Atheroembolic Renal Disease

• Published in: Clinical journal of the American Society of Nephrology Vol. 5; no. 3; pp. 454 - 459
• Main Authors: Ravani, Pietro, Gaggi, Rossella, Rollino, Cristiana, Santostefano, Marisa, Stabellini, Nevio, Colla, Loredana, Dallera, Nadia, Ravera, Sara, Bove, Sergio, Faggiano, Pompilio, Scolari, Francesco
• Format: Journal Article
• Language: English
• Published: United States Am Soc Nephrol 01.03.2010; American Society of Nephrology
• Series: Original Articles
• Subjects: Acute Kidney Injury - etiology; Acute Kidney Injury - mortality; Acute Kidney Injury - physiopathology; Acute Kidney Injury - therapy; Aged; Anticoagulants - adverse effects; Embolism, Cholesterol - complications; Embolism, Cholesterol - mortality; Embolism, Cholesterol - physiopathology; Embolism, Cholesterol - therapy; Female; Humans; Kaplan-Meier Estimate; Logistic Models; Longitudinal Studies; Male; Original; Peritoneal Dialysis - adverse effects; Peritoneal Dialysis - mortality; Proportional Hazards Models; Recovery of Function; Renal Artery Obstruction - etiology; Renal Artery Obstruction - mortality; Renal Artery Obstruction - physiopathology; Renal Artery Obstruction - therapy; Renal Dialysis - adverse effects; Renal Dialysis - mortality; Risk Assessment; Risk Factors; Time Factors; Treatment Outcome
• ISSN: 1555-9041; 1555-905X; 1555-905X
• DOI: 10.2215/CJN.06590909

Atheroembolic renal disease (AERD) can require dialytic support. Because anticoagulation may trigger atheroembolization, peritoneal dialysis may be preferred to hemodialysis. However, the effect of dialysis modality on renal and patient outcomes in AERD is unknown. A subcohort of 111 subjects who developed acute/subacute renal failure requiring dialysis was identified from a larger longitudinal study of AERD. The main exposure of interest was dialysis modality (peritoneal versus extracorporeal therapies). Logistic regression was used to study the probability of renal function recovery. Times from dialysis initiation to death were studied using Cox's regression. Eighty-six patients received hemodialysis and 25 received peritoneal dialysis. The probability of renal function recovery was similar by dialysis modality (25% among hemodialysis patients and 24% among peritoneal dialysis patients; P = 0.873). During follow-up, 58 patients died, 14 among peritoneal patients and 44 among hemodialysis patients (P = 0.705). In multivariable analysis, gastrointestinal tract involvement and use of statins maintained an independent effect on the risk of patient death. This study does not support the notion that one dialysis modality is superior to the other. However, the observational nature of the data precludes any firm conclusions.