Life expectancy is short in elderly individuals with end-stage renal failure (ESRF). This study aimed to compare mortality in patients with ESRF versus the general population (GP) to assess the evolution of excess mortality by age, gender, nephropathy, and dialysis modality after first dialysis. All incident adult dialysis patients from January 1,1999, to December 31, 2003, who lived in Rhô ne-Alpes Region (France) were included and followed up to death or December 31, 2005. Standardized mortality ratios (SMR) in comparison with GP were computed in the first to the fifth years after first dialysis. In the whole cohort (3025 incident patients), SMR decreased during these 5 yr from 7.4 to 5.2 (P ϭ 0.002). In the 18-to 44-, 45-to 64-, 65-to 74-, 75-to 84-, and Ն85-yr-old groups, SMR decreased from 26.7 to 6.2 (P ϭ 0.01), from 12.8 to 8.1 (P ϭ 0.03), from 8.6 to 5.6 (P ϭ 0.051), from 7.1 to 4.5 (P ϭ 0.02), and from 3.5 to 1.2 (P ϭ 0.14), respectively. Among age categories, differences were significant in the first 3 yr (P Ͻ 0.05). SMR were higher 1.5-fold in women than in men in the first 4 yr (P Ͻ 0.05). In patients with diabetic nephropathy (DN), SMR increased during the first 3 yr (P ϭ 0.045) and were higher than in patients without DN in the second, third, and fourth years (P Ͻ 0.05). SMR were higher in the peritoneal dialysis than in the hemodialysis group in the fourth year (P Ͻ 0.01). Patients with ESRF have a high excess mortality compared with the GP. Older patients with ESRF experienced less excess mortality. ESRF cancels out women's survival advantage noted in the GP. SMR evolution in patients with DN was different from that in patients without DN.

The aim of this study was to estimate the incidence of COVID-19 disease in the French national population of dialysis patients, their course of illness and to identify the risk factors associated with mortality. Our study included all patients on dialysis recorded in the French REIN Registry in April 2020. Clinical characteristics at last follow-up and the evolution of COVID-19 illness severity over time were recorded for diagnosed cases (either suspicious clinical symptoms, characteristic signs on the chest scan or a positive reverse transcription polymerase chain reaction) for SARS-CoV-2. A total of 1,621 infected patients were reported on the REIN registry from March 16th, 2020 to May 4th, 2020. Of these, 344 died. The prevalence of COVID-19 patients varied from less than 1% to 10% between regions. The probability of being a case was higher in males, patients with diabetes, those in need of assistance for transfer or treated at a self-care unit. Dialysis at home was associated with a lower probability of being infected as was being a smoker, a former smoker, having an active malignancy, or peripheral vascular disease. Mortality in diagnosed cases (21%) was associated with the same causes as in the general population. Higher age, hypoalbuminemia and the presence of an ischemic heart disease were statistically independently associated with a higher risk of death. Being treated at a selfcare unit was associated with a lower risk. Thus, our study showed a relatively low frequency of COVID-19 among dialysis patients contrary to what might have been assumed.

Starting patients on dialysis early has been increasing in incidence in several countries. However, some studies have questioned its utility, finding a counter-intuitive effect of increased mortality when dialysis was started at a higher estimated glomerular filtration rate (eGFR). To examine this issue in more detail we measured mortality hazard ratios associated with Modification of Diet in Renal Disease eGFR at dialysis initiation for 11,685 patients from the French REIN Registry, with sequential adjustment for a number of covariates. The eGFR was analyzed both quantitatively by 5-ml/min per 1.73 m(2) increments and by demi-decile (i.e., 5 percentiles of the distribution); the 15th demi-decile, including values around 10 ml/min per 1.73 m(2), was our reference point. The patients more likely to begin dialysis at a higher eGFR were older male patients; had diabetes, cardiovascular diseases, or low body mass index and level of albuminemia; or were started with peritoneal dialysis. During a median follow-up of 21.9 months, 3945 patients died. The 2-year crude survival decreased from 79 to 46%, with increasing eGFR from less than 5 to over 20 ml/min per 1.73 m(2). Each 5-ml/min/1.73 m(2) increase in eGFR was associated with a 40% increase in crude mortality risk, which weakened to 9%, but remained statistically significant after adjusting for the above covariates. Analysis by demi-decile showed only the highest to be at significantly higher risk. Hence we found that age and patient condition strongly determine the decision to start dialysis and may explain most of the inverse association between eGFR and survival.

OBJECTIVE -We aimed to update the epidemiology of type 1 and type 2 diabetic patients among the incident end-stage renal disease (ESRD) population in Australia and New Zealand (ANZ) and to determine whether outcome is worse for diabetic women, as described in the general population.RESEARCH DESIGNS AND METHODS -All resident adults of ANZ who began renal replacement therapy (RRT) from 1 April 1991 to 31 December 2005 were included using data from the ANZ Dialysis and Transplant Registry. Incidence rates, RRT, and survival were analyzed. Risk factors for death were assessed using Cox regression.RESULTS -The study included 1,284 type 1 diabetic (4.5%), 8,560 type 2 diabetic (30.0%), and 18,704 nondiabetic (65.5%) patients. The incidence rate of ESRD with type 2 diabetes increased markedly over time (ϩ10.2% annually, P Ͻ 0.0001). In patients aged Ͻ70 years, rates of renal transplantation in type 1 diabetic, type 2 diabetic, and nondiabetic patients were 41.8, 6.5 (P Ͻ 0.0001 vs. other patients), and 40.9% (P ϭ 0.56 vs. type 1 diabetic patients), respectively. Compared with nondiabetic patients, the adjusted hazard ratio (HR) for death was 1.64 (P Ͻ 0.0001) in type 1 diabetes and 1.13 (P Ͻ 0.0001) in type 2 diabetes. Survival rates per 5-year period improved by 6% in type 1 diabetic patients (P ϭ 0.36), by 9% in type 2 diabetic patients (P Ͻ 0.0001), and by 5% in nondiabetic patients (P ϭ 0.001). In type 2 diabetic patients aged Ն60 years, the adjusted HR for death in women versus men was 1.19 (P ϭ 0.0003).CONCLUSIONS -The incidence of ESRD with type 2 diabetes increased markedly. Despite high access to renal transplants, type 1 diabetic patients had a poor prognosis after starting RRT. Survival improved significantly in type 2 diabetic patients during the study period. Older type 2 diabetic women had a worse prognosis than older type 2 diabetic men. Diabetes Care 30:3070-3076, 2007D iabetes is associated with high mortality in the general population (1,2). Worse prognosis has also been reported in diabetic women compared with diabetic men (3,4). End-stage renal disease (ESRD) in patients with type 2 diabetes has increased dramatically worldwide during the last few decades, and diabetes is associated with worse survival among patients undergoing dialysis (5-7).Nevertheless, a study in Denmark showed that the survival rate of patients with ESRD who had type 2 diabetes has improved during the 1990 -2005 period (8). Available studies on patients with ESRD who have type 1 and type 2 diabetes have shortcomings because analyses were limited to patients with diabetic nephropathy (6 -7), did not differentiate the two types of diabetes (9), were short-term (10), or were based on single-center experiences (11).The aim of the present study was to examine the epidemiology and long-term survival of patients with incident ESRD by diabetes status (type 1 diabetes, type 2 diabetes, and no diabetes) in Australia and New Zealand (ANZ) and to determine whether outcomes were different between the sexes among patients with diabetes. RESE...

These poorly understood gender-based inequities require further consideration.

Peritoneal dialysis (PD) has been proposed as a therapeutic option for patients with end-stage renal disease and associated congestive heart failure (CHF). Here, we compare mortality risks in these patients by dialysis modality by including all patients who started planned chronic dialysis with associated congestive heart failure and were prospectively enrolled in the French REIN Registry. Survival was compared between 933 PD and 3468 hemodialysis (HD) patients using a Kaplan-Meier model, Cox regression, and propensity score analysis. The patients were followed from their first dialysis session and stratified by modality at day 90 or last modality if death occurred prior. There was a significant difference in the median survival time of 20.4 months in the PD group and 36.7 months in the HD group (hazard ratio, 1.55). After correction for confounders, the adjusted hazard ratio for death in PD compared to the HD patients remained significant at 1.48. Subgroup analyses showed that the results were not changed with regard to the New York Heart Association stage, age strata, or estimated glomerular filtration rate strata at first renal replacement therapy. The use of propensity score did not change results (adjusted hazard ratio, 1.55). Thus, mortality risk was higher with PD than with HD among incident patients with end-stage renal disease and congestive heart failure. These results may help guide clinical decisions and also highlight the need for randomized clinical trials.

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Several studies have investigated geographical variations in access to renal transplant waiting lists, but none has assessed the impact on these variations of factors at both the patient and geographic levels. The objective of our study was to identify medical and nonmedical factors at both these levels associated with these geographical variations in waiting-list placement in France. We included all incident patients aged 18-80 years in 11 French regions who started dialysis between January 1, 2006, and December 31, 2008. Both a multilevel Cox model with shared frailty and a competing risks model were used for the analyses. At the patient level, old age, comorbidities, diabetic nephropathy, non-autonomous first dialysis, and female gender were the major determinants of a lower probability of being waitlisted. At the regional level, the only factor associated with this probability was an increase in the number of patients on the waiting list from 2005 to 2009. This finding supports a slight but significant impact of a regional organ shortage on waitlisting practices. Our findings demonstrate that patients' age has a major impact on waitlisting practices, even for patients with no comorbidity or disability, whose survival would likely be improved by transplantation compared with dialysis.