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Ratio of blood urea nitrogen to serum creatinine at initiation of dialysis is associated with mortality: a multicenter prospective cohort study

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Abstract

Background

Some studies have shown that the estimated glomerular filtration rate (eGFR) at the time of initiating dialysis was associated with mortality. However, the relationship between ratio of blood urea nitrogen to serum creatinine (BUN/Cr) and mortality is unknown.

Methods

The study was a multicenter, prospective cohort analysis including 1520 patients. Patients were classified into four quartiles based on the BUN/Cr ratio at the dialysis initiation, with Q1 having the lowest ratio and Q4 the highest. All-cause mortality after initiating dialysis was compared using the log-rank test. All-cause mortality of Q1, Q2, and Q3 was compared with that of Q4 using multivariate Cox proportional hazard regression analysis. Moreover, we compared the renal parameters including BUN/Cr ratio, eGFR, and creatinine clearance for sensitivity and specificity using receiver operative characteristic (ROC) curve.

Results

Significant differences were observed in all-cause mortality among the four groups (p < 0.001). Multivariate analysis revealed that all-cause mortality was significantly higher in Q4 than in Q1 [hazard ratio (HR) = 1.82, 95% confidence interval (CI) 1.24–2.67, p = 0.002]. The increase in BUN/Cr ratio was positively associated with mortality (HR 1.04, 95% CI 1.02–1.06, p = 0.002). The sensitivity and specificity of BUN/Cr ratio for 180, 365, 730, and 1095 days mortality ranged between 0.60–0.72 and 0.59–0.71, respectively. The area under the curve of BUN/Cr for all-cause mortality was the highest among the renal parameters.

Conclusion

The BUN/Cr ratio at the time of initiation of dialysis was associated with all-cause mortality.

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Acknowledgements

We acknowledge the support provided by the following investigators and members of the Aichi Cohort study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP), who participated in this study: Akihito Tanaka, Minako Murata, Hibiki Shinjo, Yasuhiro Otsuka, Asami Takeda (Japanese Red Cross Nagoya Daini Hospital), Hirofumi Tamai (Anjo Kosei Hospital), Tomohiko Naruse (Kasugai Municipal Hospital), Kei Kurata (Tosei General Hospital), Hideto Oishi (Komaki City Hospital), Isao Aoyama (Japanese Community Healthcare Organization Chukyo Hospital), Hiroshi Ogawa (Shinseikai Daiichi Hospital), Hiroko Kushimoto (Chita City Hospital), Hideaki Shimizu (Chubu-Rosai Hospital), Junichiro Yamamoto (Tsushima City Hospital), Hisashi Kurata (Toyota Kosei Hospital), Taishi Yamakawa (Toyohashi Municipal Hospital), TakaakiYaomura (Nagoya Medical Center), Hirotake Kasuga (Nagoya Kyouritsu Hospital), Shizunori Ichida (Japanese Red Cross Nagoya Daiichi Hospital), Shoichi Maruyama (Nagoya University Graduate School of Medicine), Seiichi Matsuo (Nagoya University Graduate School of Medicine), Noritoshi Kato (Nagoya University Graduate School of Medicine).

Author information

Authors and Affiliations

  1. Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan

    Daijo Inaguma, Shigehisa Koide, Eri Ito, Kazuo Takahashi, Hiroki Hayashi, Midori Hasegawa & Yukio Yuzawa

  2. The Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP) Group, Toyoake, Japan

    Daijo Inaguma & Shigehisa Koide

Authors
  1. Daijo Inaguma
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  2. Shigehisa Koide
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  3. Eri Ito
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  4. Kazuo Takahashi
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  5. Hiroki Hayashi
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  6. Midori Hasegawa
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  7. Yukio Yuzawa
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Consortia

AICOPP group

  • Akihito Tanaka
  • , Minako Murata
  • , Hibiki Shinjo
  • , Yasuhiro Otsuka
  • , Asami Takeda
  • , Hirofumi Tamai
  • , Tomohiko Naruse
  • , Kei Kurata
  • , Hideto Oishi
  • , Isao Aoyama
  • , Hiroshi Ogawa
  • , Hiroko Kushimoto
  • , Hideaki Shimizu
  • , Junichiro Yamamoto
  • , Hisashi Kurata
  • , Taishi Yamakawa
  • , Takaaki Yaomura
  • , Hirotake Kasuga
  • , Shizunori Ichida
  • , Shoichi Maruyama
  • , Seiichi Matsuo
  •  & Noritoshi Kato

Contributions

DI participated in the design of the study and interpretation of data. DI, EI, and SK surveyed and collected information about prognosis. KT and HH performed statistical analyses. DI drafted the manuscript and MH and YY revised it critically for important intellectual content. All authors read and approved the final manuscript.

Corresponding author

Correspondence to Daijo Inaguma.

Ethics declarations

Conflict of interest

The authors declare that they have no competing interests.

Ethics approval and consent to participate

This study was conducted by following Ethical guidelines for Clinical Research by the Japanese Ministry of Health, Labor, and Welfare (created July 30, 2003; full revision December 28, 2004; full revision July 31, 2008) and the Helsinki Declaration (revised 2013) and was approved by the clinical research ethics committees at each AICOPP group facility (the approval number: 20110823-3). The subjects received oral and written explanations of the purpose of the study and provided their consent in writing. Trial registration is UMIN 7096. Registered 18 January 2012.

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Inaguma, D., Koide, S., Ito, E. et al. Ratio of blood urea nitrogen to serum creatinine at initiation of dialysis is associated with mortality: a multicenter prospective cohort study. Clin Exp Nephrol 22, 353–364 (2018). https://doi.org/10.1007/s10157-017-1458-x

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  • DOI: https://doi.org/10.1007/s10157-017-1458-x

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