Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the French REIN registry using a multi-state model. Beuscart, J., Pagniez, D., Boulanger, E., & Duhamel, A. Journal of Epidemiology / Japan Epidemiological Association, 25(2):133–141, 2015.
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BACKGROUND: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration. METHODS: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death. RESULTS: During the study, 1392 (19.5%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9%) were observed in the not wait-listed group compared with only 33 (1.1%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age. CONCLUSIONS: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.
@article{beuscart_registration_2015,
	title = {Registration on the renal transplantation waiting list and mortality on dialysis: an analysis of the {French} {REIN} registry using a multi-state model},
	volume = {25},
	issn = {1349-9092},
	shorttitle = {Registration on the renal transplantation waiting list and mortality on dialysis},
	doi = {10.2188/jea.JE20130193},
	abstract = {BACKGROUND: Access to the renal transplantation (RT) waiting list depends on factors related to lower mortality rates and often occurs after dialysis initiation. The aim of the study was to use a flexible regression model to determine if registration on the RT waiting list is associated with mortality on dialysis, independent of the comorbidities associated with such registration.
METHODS: Data from the French REIN registry on 7138 incident hemodialysis (HD) patients were analyzed. A multi-state model including four states ('HD, not wait-listed', 'HD, wait-listed', 'death', and 'RT') was used to estimate the effect of being wait-listed on the probability of death.
RESULTS: During the study, 1392 (19.5\%) patients were wait-listed. Of the 2954 deaths observed in the entire cohort during follow-up, 2921 (98.9\%) were observed in the not wait-listed group compared with only 33 (1.1\%) in the wait-listed group. In the multivariable analysis, the adjusted hazard ratio for death associated with non-registration on the waiting list was 3.52 (95\% CI, 1.70-7.30). The risk factors for death identified for not wait-listed patients were not found to be significant risk factors for wait-listed patients, with the exception of age.
CONCLUSIONS: The use of a multi-state model allowed a flexible analysis of mortality on dialysis. Patients who were not wait-listed had a much higher risk of death, regardless of co-morbidities associated with being wait-listed, and did not share the same risk factors of death as wait-listed patients. Registration on the waiting list should therefore be taken into account in survival analysis of patients on dialysis.},
	language = {eng},
	number = {2},
	journal = {Journal of Epidemiology / Japan Epidemiological Association},
	author = {Beuscart, Jean-Baptiste and Pagniez, Dominique and Boulanger, Eric and Duhamel, Alain},
	year = {2015},
	pmid = {25721069},
	pmcid = {PMC4310874},
	pages = {133--141},
}

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