Cardiovascular event risk dynamics over time in older patients on dialysis: A generalized multiple-index varying coefficient model approach

Jason P. Estes, Danh V. Nguyen, Lorien Dalrymple, Yi Mu, Damla Şentürk

Research output: Contribution to journalArticle

7 Citations (Scopus)

Abstract

Among patients on dialysis, cardiovascular disease and infection are leading causes of hospitalization and death. Although recent studies have found that the risk of cardiovascular events is higher after an infection-related hospitalization, studies have not fully elucidated how the risk of cardiovascular events changes over time for patients on dialysis. In this work, we characterize the dynamics of cardiovascular event risk trajectories for patients on dialysis while conditioning on survival status via multiple time indices: (1) time since the start of dialysis, (2) time since the pivotal initial infection-related hospitalization, and (3) the patient's age at the start of dialysis. This is achieved by using a new class of generalized multiple-index varying coefficient (GM-IVC) models. The proposed GM-IVC models utilize a multiplicative structure and one-dimensional varying coefficient functions along each time and age index to capture the cardiovascular risk dynamics before and after the initial infection-related hospitalization among the dynamic cohort of survivors. We develop a two-step estimation procedure for the GM-IVC models based on local maximum likelihood. We report new insights on the dynamics of cardiovascular events risk using the United States Renal Data System database, which collects data on nearly all patients with end-stage renal disease in the United States. Finally, simulation studies assess the performance of the proposed estimation procedures.

Original languageEnglish (US)
Pages (from-to)754-764
Number of pages11
JournalBiometrics
Volume70
Issue number3
DOIs
StatePublished - Sep 1 2014

Fingerprint

Varying Coefficient Model
Dialysis
dialysis
Infection
Hospitalization
infection
Cardiovascular Infections
Local Likelihood
Varying Coefficients
Database Systems
kidney diseases
Information Systems
Conditioning
cardiovascular diseases
Maximum likelihood
Chronic Kidney Failure
trajectories
Maximum Likelihood
Survivors
Cause of Death

Keywords

  • Cardiovascular outcomes
  • End stage renal disease
  • Generalized linear models
  • Infection
  • Time-varying effects
  • United States renal data system

ASJC Scopus subject areas

  • Applied Mathematics
  • Statistics and Probability
  • Agricultural and Biological Sciences(all)
  • Biochemistry, Genetics and Molecular Biology(all)
  • Immunology and Microbiology(all)
  • Medicine(all)

Cite this

Cardiovascular event risk dynamics over time in older patients on dialysis : A generalized multiple-index varying coefficient model approach. / Estes, Jason P.; Nguyen, Danh V.; Dalrymple, Lorien; Mu, Yi; Şentürk, Damla.

In: Biometrics, Vol. 70, No. 3, 01.09.2014, p. 754-764.

Research output: Contribution to journalArticle

Estes, Jason P. ; Nguyen, Danh V. ; Dalrymple, Lorien ; Mu, Yi ; Şentürk, Damla. / Cardiovascular event risk dynamics over time in older patients on dialysis : A generalized multiple-index varying coefficient model approach. In: Biometrics. 2014 ; Vol. 70, No. 3. pp. 754-764.
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