ASSOCIATION BETWEEN ALCOHOL CONSUMPTION AND ALL-CAUSE MORTALITY IN PATIENT UNDERGOING HEMODIALYSIS: A SURVIVAL ANALYSIS FROM THE DIET-HD COHORT

 

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https://storage.unitedwebnetwork.com/files/1099/a15e523bf33b166c688f24868b233990.pdf
ASSOCIATION BETWEEN ALCOHOL CONSUMPTION AND ALL-CAUSE MORTALITY IN PATIENT UNDERGOING HEMODIALYSIS: A SURVIVAL ANALYSIS FROM THE DIET-HD COHORT

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Amelie
Bernier-Jean
Pierre-Henri Heitz pierre-henri.heitz@umontreal.ca Université de Montreal Faculté de Médecine Montreal Canada - CIUSSS du Nord-de-l'Île-de-Montreal Centre de Recherche Montreal Canada
Giovanni F.M. Strippoli gfmstrippoli@gmail.com The University of Sydney School of Public Health, Faculty of Medicine and Health Sydney Australia - University of Bari Department of Emergency and Organ Transplantation Bari Italy
Valeria Saglimbene vsag1982@gmail.com University of Bari Department of Emergency and Organ Transplantation Bari Italy -
Amelie Bernier-Jean amelie.jean-bernier@umontreal.ca Université de Montreal Faculté de Médecine Montreal Canada * CIUSSS du Nord-de-l'Île-de-Montreal Centre de Recherche Montreal Canada
 
 
 
 
 
 
 
 
 
 
 

Patients on hemodialysis face a mortality risk eight times higher than that of the general population. While alcohol consumption is associated with increased mortality in the general population, its impact among hemodialysis patients remains unclear. This study aimed to evaluate the association between alcohol consumption and all-cause mortality in this population.

We prospectively assessed alcohol intake using the food frequency questionnaire in hemodialysis patients from Europe and Argentina. Alcohol consumption was divided as abstinent, occasional drinker (<14 g/day) and regular drinker (>14 g/day). Fourteen grams of alcohol, equivalent to one standard drink, corresponds to slightly more than a beer bottle and one glass of wine, or slightly less than a glass of spirits. Participants were followed until death or discharge from the dialysis unit. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular and non-cardiovascular mortality. We examined associations using Cox proportional hazards (PH) models as the primary analysis and Fine and Gray competing risks models as secondary analysis, as well as a dose response analysis. Confounding by demographic, clinical and lifestyle factors was addressed using propensity score inverse probability weighting.

Among 7,917 participants, 1,702 (22%) were abstinent, 5,387 (68%) were occasional drinkers, and 828 (11%) were regular drinkers. Wine accounted for 77% of total alcohol consumed, with a mean intake was 26 g/day among regular drinkers. Over a median follow-up of 4.0 years (25,438 person-years), 3,753 deaths (36%) occurred. In the weighted and adjusted Cox PH model, all-cause mortality was lower among occasional drinkers (HR = 0.84; 95% CI: 0.75–0.95; p = 0.006), but not among regular drinkers (HR = 0.87; 95% CI: 0.71–1.06; p = 0.16). Non-cardiovascular mortality was lower among occasional (HR = 0.81; 95% CI: 0.68–0.95; p = 0.01) and regular drinkers (HR = 0.71; 95% CI: 0.53–0.95; p = 0.02), whereas cardiovascular mortality showed no significant association. In the dose–response analysis, the unadjusted model showed a J-shaped curve, with the lowest relative risk around 10–15 g/day followed by a rise at higher intakes. After adjustment for covariates, the association was substantially attenuated but remained nonlinear.

In this large cohort of adults receiving maintenance hemodialysis, moderate alcohol consumption was not associated with increased mortality. A possible protective association was observed among occasional drinkers, mainly for non-cardiovascular mortality, although residual confounding cannot be excluded.

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