Table 4.
Unadjusted and adjusted associations of IDH with incident clinical outcomes (n=39,497)
| IDHa | Crude | Adjustedb | ||
|---|---|---|---|---|
| HR (95% CI) | P | HR (95% CI) | P | |
| All-cause mortality (7646 qualifying events) | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.00 (0.95 to 1.06) | 0.94 | 1.07 (1.01 to 1.14) | 0.01 |
| >0% to ≤5% of treatments (versus absent) | 1.05 (0.98 to 1.13) | 0.17 | ||
| >5% to ≤10% of treatments (versus absent) | 1.04 (0.95 to 1.14) | 0.41 | ||
| >10% of treatments (versus absent) | 1.19 (1.06 to 1.34) | 0.004 | ||
| CV mortality (2976 qualifying events)c | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 0.93 (0.85 to 1.02) | 0.14 | 1.00 (0.91 to 1.10) | 0.99 |
| >0 to ≤5% of treatments (versus absent) | 0.96 (0.85 to 1.09) | 0.55 | ||
| >5 to ≤10% of treatments (versus absent) | 0.94 (0.81 to 1.10) | 0.46 | ||
| >10% of treatments (versus absent) | 1.22 (1.02 to 1.48) | 0.03 | ||
| Myocardial infarction (2396 qualifying events) | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.14 (1.04 to 1.24) | 0.01 | 1.20 (1.10 to 1.31) | <0.001 |
| >0 to ≤5% of treatments (versus absent) | 1.15 (1.04 to 1.30) | 0.01 | ||
| >5 to ≤10% of treatments (versus absent) | 1.27 (1.10 to 1.45) | 0.001 | ||
| >10% of treatments (versus absent) | 1.20 (1.00 to 1.45) | 0.05 | ||
| Hospitalization for HF/volume overload (8896 qualifying outcomes) | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.08 (1.04 to 1.13) | <0.001 | 1.13 (1.08 to 1.18) | <0.001 |
| >0% to ≤5% of treatments (versus absent) | 1.09 (1.03 to 1.15) | 0.01 | ||
| >5% to ≤10% of treatments (versus absent) | 1.16 (1.08 to 1.25) | <0.001 | ||
| >10% of treatments (versus absent) | 1.22 (1.11 to 1.34) | <0.001 | ||
| Composite hospitalization for HF/volume overload or CV mortality (10,805 qualifying outcomes)c | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.08 (1.03 to 1.12) | <0.001 | 1.12 (1.08 to 1.17) | <0.001 |
| >0% to ≤5% of treatments (versus absent) | 1.08 (1.02 to 1.14) | 0.01 | ||
| >5% to ≤10% of treatments (versus absent) | 1.14 (1.06 to 1.22) | <0.001 | ||
| >10% of treatments (versus absent) | 1.26 (1.15 to 1.37) | <0.001 | ||
| MACEs (4994 qualifying events)d | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.04 (0.97 to 1.11) | 0.27 | 1.10 (1.03 to 1.17) | 0.01 |
| >0% to ≤5% of treatments (versus absent) | 1.06 (0.97 to 1.15) | 0.18 | ||
| >5% to ≤10% of treatments (versus absent) | 1.09 (0.98 to 1.22) | 0.10 | ||
| >10% of treatments (versus absent) | 1.23 (1.08 to 1.41) | 0.002 | ||
| MACEs+ (12,221 qualifying events)e | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 1.08 (1.04 to 1.12) | <0.001 | 1.14 (1.09 to 1.19) | <0.001 |
| >0% to ≤5% of treatments (versus absent) | 1.08 (1.02 to 1.14) | 0.004 | ||
| >5% to ≤10% of treatments (versus absent) | 1.17 (1.10 to 1.25) | <0.001 | ||
| >10% of treatments (versus absent) | 1.29 (1.19 to 1.40) | <0.001 | ||
| Hospitalization for atrial fibrillation (2789 qualifying events) | ||||
| IDH absent | 1 (ref) | — | 1 (ref) | — |
| IDH present overall (versus absent) | 0.89 (0.82 to 0.97) | 0.01 | 1.04 (0.95 to 1.13) | 0.38 |
| >0% to ≤5% of treatments (versus absent) | 1.00 (0.90 to 1.11) | 0.98 | ||
| >5% to ≤10% of treatments (versus absent) | 1.03 (0.89 to 1.18) | 0.72 | ||
| >10% of treatments (versus absent) | 1.19 (1.00 to 1.42) | 0.07 | ||
Estimates reported as HRs (95% CIs). n=27,212 (68.9%) for IDH absent and n=12,285 (31.1%) for IDH present. HR, hazard ratio.
IDH defined during the exposure assessment period (dialysis days 91–180) as a fall in systolic BP (predialysis to nadir intradialytic) of ≥20 mmHg accompanied by at least two responsive measures (reduction in ultrafiltration rate, reduction in blood flow rate, administration of saline, or premature cessation of dialysis).Outcomes considered beginning on dialysis day 181 and continuing until death or censoring (as described in the text). Cumulative patient-years at risk were 26,245 for hospitalization for HF/volume overload, 26,206 for composite hospitalization for HF/volume overload or CV mortality, 29,249 for CV mortality, 29,210 for all-cause mortality, 30,595 for myocardial infarction, 29,594 for MACEs, 25,891 for MACEs+, 29,062 for postdialytic complications, and 27,105 for hospitalization for atrial fibrillation.
Adjusted for age, race, sex, cause of ESRD, prior renal transplant, access type, uncontrolled hypertension (mean predialysis BP>140/90 mmHg or mean postdialysis BP>130/85 mmHg during exposure period; dialysis days 91–180), and the following prevalent at baseline (on or before dialysis day 180): diabetes, HF, myocardial infarction, atrial fibrillation, and cerebrovascular disease (ischemic/hemorrhagic stroke or transient ischemic attack).
CV deaths defined as those attributed to myocardial infarction, atherosclerotic heart disease, cardiac arrhythmia, congestive HF, cardiomyopathy, cardiac arrest, valvular heart disease, pulmonary edema, cerebrovascular accident including intracranial hemorrhage, or ischemic brain damage/anoxic encephalopathy.
MACEs defined as nonfatal myocardial infarction, nonfatal stroke, or CV mortality.
MACEs+ defined as nonfatal myocardial infarction, nonfatal stroke, CV mortality, arrhythmia, nonfatal hemorrhagic stroke, or hospitalization for HF/volume overload.