{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,23]],"date-time":"2026-10-23T03:58:41Z","timestamp":1792727921587,"version":"4.5.0"},"reference-count":24,"publisher":"Public Library of Science (PLoS)","issue":"8","license":[{"start":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T00:00:00Z","timestamp":1629417600000},"content-version":"vor","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/100008723","name":"Suomen L\u00e4\u00e4ketieteen S\u00e4\u00e4ti\u00f6","doi-asserted-by":"publisher","id":[{"id":"10.13039\/100008723","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":["www.plosone.org"],"crossmark-restriction":false},"short-container-title":["PLoS ONE"],"abstract":"<jats:sec id=\"sec001\">\n<jats:title>Background<\/jats:title>\n<jats:p>Comorbidities are associated with increased mortality among patients receiving long-term kidney replacement therapy (KRT). However, it is not known whether primary kidney disease modifies the effect of comorbidities on KRT patients\u2019 survival.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec002\">\n<jats:title>Methods<\/jats:title>\n<jats:p>An incident cohort of all patients (n = 8696) entering chronic KRT in Finland in 2000\u20132017 was followed until death or end of 2017. All data were obtained from the Finnish Registry for Kidney Diseases. Information on comorbidities (coronary artery disease, peripheral vascular disease, left ventricular hypertrophy, heart failure, cerebrovascular disease, malignancy, obesity, underweight, and hypertension) was collected at the start of KRT. The main outcome measure was relative risk of death according to comorbidities analyzed in six groups of primary kidney disease: type 2 diabetes, type 1 diabetes, glomerulonephritis (GN), polycystic kidney disease (PKD), nephrosclerosis, and other or unknown diagnoses. Kaplan-Meier estimates and Cox regression were used for survival analyses.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec003\">\n<jats:title>Results<\/jats:title>\n<jats:p>In the multivariable model, heart failure increased the risk of death threefold among PKD and GN patients, whereas in patients with other kidney diagnoses the increased risk was less than twofold. Obesity was associated with worse survival only among GN patients. Presence of three or more comorbidities increased the age- and sex-adjusted relative risk of death 4.5-fold in GN and PKD patients, but the increase was only 2.5-fold in patients in other diagnosis groups.<\/jats:p>\n<\/jats:sec>\n<jats:sec id=\"sec004\">\n<jats:title>Conclusions<\/jats:title>\n<jats:p>Primary kidney disease should be considered when assessing the effect of comorbidities on survival of KRT patients as it varies significantly according to type of primary kidney disease.<\/jats:p>\n<\/jats:sec>","DOI":"10.1371\/journal.pone.0256522","type":"journal-article","created":{"date-parts":[[2021,8,20]],"date-time":"2021-08-20T18:21:00Z","timestamp":1629483660000},"page":"e0256522","update-policy":"https:\/\/doi.org\/10.1371\/journal.pone.corrections_policy","source":"Crossref","is-referenced-by-count":5,"title":["Primary kidney disease modifies the effect of comorbidities on kidney replacement therapy patients\u2019 survival"],"prefix":"10.1371","volume":"16","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8962-0702","authenticated-orcid":true,"given":"Jaakko","family":"Helve","sequence":"first","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Mikko","family":"Haapio","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Per-Henrik","family":"Groop","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Patrik","family":"Finne","sequence":"additional","affiliation":[],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"340","published-online":{"date-parts":[[2021,8,20]]},"reference":[{"key":"pone.0256522.ref001","doi-asserted-by":"crossref","first-page":"415","DOI":"10.1016\/0140-6736(93)93003-J","article-title":"Influence of coexisting disease on survival on renal-replacement therapy","volume":"341","author":"IH Khan","year":"1993","journal-title":"Lancet"},{"key":"pone.0256522.ref002","doi-asserted-by":"crossref","first-page":"3270","DOI":"10.1097\/01.ASN.0000100127.54107.57","article-title":"Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)","volume":"14","author":"DA Goodkin","year":"2003","journal-title":"J Am Soc Nephrol"},{"key":"pone.0256522.ref003","doi-asserted-by":"crossref","first-page":"1663","DOI":"10.1007\/s00125-011-2140-6","article-title":"Comorbidities and survival of patients with type 1 diabetes on renal replacement therapy","volume":"54","author":"J Helve","year":"2011","journal-title":"Diabetologia"},{"key":"pone.0256522.ref004","doi-asserted-by":"crossref","first-page":"1794","DOI":"10.1093\/ndt\/gfx355","article-title":"Changes in co-morbidity patterns in patients starting renal replacement therapy in Europe\u2013data from the ERA-EDTA Registry","volume":"33","author":"ML Ceretta","year":"2018","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0256522.ref005","doi-asserted-by":"crossref","first-page":"894","DOI":"10.1053\/j.ajkd.2010.12.023","article-title":"Predicting mortality in incident dialysis patients: an analysis of the United Kingdom Renal Registry","volume":"57","author":"M Wagner","year":"2011","journal-title":"Am J Kidney Dis"},{"key":"pone.0256522.ref006","doi-asserted-by":"crossref","first-page":"666","DOI":"10.1503\/cmaj.091661","article-title":"Predicting potential survival benefit of renal transplantation in patients with chronic kidney disease","volume":"182","author":"C van Walraven","year":"2010","journal-title":"CMAJ"},{"key":"pone.0256522.ref007","doi-asserted-by":"crossref","first-page":"187","DOI":"10.1093\/ndt\/gfl502","article-title":"Confounding effect of comorbidity in survival studies in patients on renal replacement therapy","volume":"22","author":"JG van Manen","year":"2007","journal-title":"Nephrol Dial Transplant"},{"key":"pone.0256522.ref008","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.2215\/CJN.00050119","article-title":"Prediction of Risk of Death for Patients starting Dialysis: A Sistematic Review and Meta-Analysis","volume":"14","author":"RT Anderson","year":"2019","journal-title":"Clin J Am Soc Nephrol"},{"key":"pone.0256522.ref009","doi-asserted-by":"crossref","first-page":"82","DOI":"10.1053\/ajkd.2002.33916","article-title":"How to adjust for comorbidity in survival studies in ESRD patients: a comparison of different indices","volume":"40","author":"NECOSAD Study Group. 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