Document Detail

Modelling competing risks in nephrology research: an example in peritoneal dialysis.
MedLine Citation:
PMID:  23705871     Owner:  NLM     Status:  Publisher    
BACKGROUND: Modelling competing risks is an essential issue in Nephrology Research. In peritoneal dialysis studies, sometimes inappropriate methods (i.e. Kaplan-Meier method) have been used to estimate probabilities for an event of interest in the presence of competing risks. In this situation a competing risk analysis should be preferable. The objectives of this study are to describe the bias resulting from the application of standard survival analysis to estimate peritonitis-free patient survival and to provide alternative statistical approaches taking competing risks into account. METHODS: The sample comprises patients included in a university hospital peritoneal dialysis program between October 1985 and June 2011 (n = 449). Cumulative incidence function and competing risk regression models based on cause-specific and subdistribution hazards were discussed. RESULTS: The probability of occurrence of the first peritonitis is wrongly overestimated using Kaplan-Meier method. The cause-specific hazard model showed that factors associated with shorter time to first peritonitis were age (>=55 years) and previous treatment (haemodialysis). Taking competing risks into account in the subdistribution hazard model, age remained significant while gender (female) but not previous treatment was identified as a factor associated with a higher probability of first peritonitis event. CONCLUSIONS: In the presence of competing risks outcomes, Kaplan-Meier estimates are biased as they overestimated the probability of the occurrence of an event of interest. Methods which take competing risks into account provide unbiased estimates of cumulative incidence for each specific outcome experienced by patients. Multivariable regression models such as those based on cause-specific hazard and on subdistribution hazard should be used in this competing risk setting.
Laetitia Teixeira; Anabela Rodrigues; Maria J Carvalho; António Cabrita; Denisa Mendonça
Publication Detail:
Type:  JOURNAL ARTICLE     Date:  2013-5-24
Journal Detail:
Title:  BMC nephrology     Volume:  14     ISSN:  1471-2369     ISO Abbreviation:  BMC Nephrol     Publication Date:  2013 May 
Date Detail:
Created Date:  2013-5-27     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  100967793     Medline TA:  BMC Nephrol     Country:  -    
Other Details:
Languages:  ENG     Pagination:  110     Citation Subset:  -    
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