Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States

Abstract

Abstract. Mortality rates among hemodialysis patients vary greatly across regions. Representative databases containing extensive profiles of patient characteristics and outcomes are lacking. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States (US) that captures extensive data relating to patient characteristics, prescriptions, laboratory values, practice patterns, and outcomes. This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr. The crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. After adjusting for age, gender, race, and 25 comorbid conditions, the relative risk (RR) of mortality was 2.84 (P Ͻ 0.0001) for Europe compared with Japan (reference group) and was 3.78 (P Ͻ 0.0001) for the US compared with Japan. The adjusted RR of mortality for the US versus Europe was 1.33 (P Ͻ 0.0001). For most comorbid diseases, prevalence was highest in the US, where the mean age (60.5 Ϯ 15.5 yr) was also highest. Older age and comorbidities were associated with increased risk of death (except for hypertension, which carried a multivariate RR of mortality of 0.74 [P Ͻ 0.0001]). Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US. Adjustments for the observed variability will allow study of association between practice patterns and outcomes.Outcomes among dialysis patients differ considerably between and within countries. One of the most concerning differences is the varying mortality rate across countries with large populations of dialysis patients. Held et al. (1) reported the mortality risk for the renal replacement population in the United States (US), adjusted for age and diabetes mellitus, to be 15% higher than the European risk and 33% higher than the Japanese risk.

Mortality among hemodialysis patients in Europe, Japan, and the United States: Case-mix effects

“…1,3 The prevalence of case-mix characteristics was determined by examining records from an international cross-sectional cohort of 8,615 patients. Mortality was recorded for this inception cohort, plus replacement patients, for a total of 16,720 patients, from 1996 through 2002.…”

“…5 The case definitions for the other comorbid diseases are delineated in the appendix to the original comorbidities report. 3 Hepatitis B seroconversion was defined as documented change from negative HBV surface antigen status at entry to positive while on study. Similarly, patients who were HCV antibody negative at study entry and subsequently found to be HCV antibody positive were defined as cases of HCV seroconversion.…”

“…The first analysis of case-mix versus mortality in the DOPPS included 16,720 patients, followed up to 5 years, in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States. 3 The international collection of comprehensive, prospective data from representative samples of hemodialysis facilities and patients provides an unprecedented opportunity to study associations between multiple variables and critical outcomes, including death, hospitalization, quality of life, and vascular access fates.…”

Clinical Efficacy and Cost-Effectiveness of Lanthanum Carbonate as Second-Line Therapy in Hemodialysis Patients in Japan

“…These results seems worthy of consideration with regard to the application of our results to other populations. First, it is well known that one of the features of hemodialysis patients in Japan is longevity (45); however, changes in mortality rates had little impact on the ICER as shown in Figure 3. Differences in underlying primary kidney disease may also affect the incidences of CVD, fracture, and death, but changes in these incidence rates had little impact on the ICER in our analysis.…”

An introduction to CKD-MBD research: restart for the future

“…Care of CKD patients, especially for dialysis patients, has been traditionally quite intensive in Japan, which could have potentially contributed to the much better prognosis than other countries [12]. Achievement of strict target range of mineral parameters by Japanese guidelines [13,14], especially focused on phosphorus [15,16], may in part explain such a better prognosis [17].…”