Death during the first 90 days of dialysis: A case control study

Khan, Izhar; Catto, G. R. D.; Edward, N.; MacLeod, Alison Murray

doi:10.1016/0272-6386(95)90009-8

Cited by 131 publications

(81 citation statements)

References 11 publications

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“…For example, patients younger than 65 and not medically disabled must wait at least 90 days after their first ESRD service date before they become Medicare eligible. The few studies of incident dialysis patients in these initial 90 days have reported variable early mortality rates between 24 and 50 deaths per 100 patient-years (12)(13)(14)19,20,23). Such inconsistencies between studies may occur because incident patients may be unintentionally censored prematurely from disease registries, which may obscure important outcomes that occur in the first 3 months of dialysis.…”

Section: Discussionmentioning

confidence: 99%

“…Indeed, most clinical trials have included prevalent and not incident patients, and data collection in this initial 90-day period is limited (15)(16)(17)(18). The few studies on early dialysis mortality have reported rates well above the national ESRD annual mortality rate of approximately 20% (12)(13)(14)19,20); however, the magnitude, progression, and risk factors associated with this early mortality remain unclear given marked differences in the reported death rate among these studies. Herein, we describe the characteristics, …”

Section: Introductionmentioning

confidence: 99%

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Early Outcomes among Those Initiating Chronic Dialysis in the United States

Chan

Maddux²,

Tolkoff-Rubin³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

144

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SummaryBackground and objectives Approximately one million Americans initiated chronic dialysis over the past decade; the first-year mortality rate reported by the U.S. Renal Data System was 19.6% in 2007. This estimate has historically excluded the first 90 days of chronic dialysis.Design, setting, participants, & measurements To characterize the mortality and hospitalization risks for patients starting chronic renal replacement therapy, we followed all patients initiating dialysis in 1733 facilities throughout the United States (n ϭ 303,289). Mortality and hospitalizations within the first 90 days were compared with outcomes after this period, and the results were analyzed. Standard time-series analyses were used to depict the weekly risk estimates for each outcome.Results Between 1997 and 2009, Ͼ300,000 patients initiated chronic dialysis and were followed for Ͼ35 million dialysis treatments; the highest risk for morbidity and mortality occurred in the first 2 weeks of treatment. The initial 2-week risk of death for a typical dialysis patient was 2.72-fold higher, and the risk of hospitalization was 1.95-fold higher when compared to a patient who survived the first year of chronic dialysis (week 53 after initiation). Similarly, over the first 90 days, the risk of mortality and hospitalization remained elevated. Thereafter, between days 91 and 365, these risks decreased considerably by more than half. Surviving these first weeks of dialysis was most associated with the type of vascular access. Initiating dialysis with a fistula was associated with a decreased early death risk by 61%, whereas peritoneal dialysis decreased the risk by 87%. ConclusionsThe first 2 weeks of chronic dialysis are associated with heightened mortality and hospitalization risks, which remain elevated over the ensuing 90 days.

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Early Outcomes among Those Initiating Chronic Dialysis in the United States

Chan

Maddux²,

Tolkoff-Rubin³

et al. 2011

Clinical Journal of the American Society of Nephrology

130

144

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“…Hanya sedikit penelitian yang fokus pada kesintasan pada periode awal setelah inisiasi dialisis. [7][8][9][10][11][12] Bahkan, angka kematian tahun pertama yang dilaporkan oleh U.S. Renal Data System sebesar 19,6% pada tahun 1997 pada analisisnya mengeksklusi pasien yang meninggal dalam 90 hari pertama setelah HD. Padahal, penelitian lainnya menyebutkan bahwa angka kematian justru didapatkan tertinggi pada minggu-minggu pertama setelah HD.…”

Section: Pendahuluanunclassified

“…Untuk memudahkan penerapan klinis skor dibagi menjadi 3 kelompok berdasarkan persentase probabilitas kematian, yaitu risiko ringan (skor 0-3), sedang (skor 4-6) dan tinggi (7)(8)(9). Probabilitas mortalitas masing-masing kelompok dapat dilihat pada tabel 5.8.…”

Section: Penelitian Tahun Nilai Batas Hemoglobin (G/dl)unclassified

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

Umami¹,

Lydia²,

Nainggolan³

et al. 2017

JPDI

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ABSTRAKPendahuluan. Mortalitas pasien yang menjalani hemodialisis (HD) paling tinggi pada tiga bulan pertama. Data mengenai insidens dan prediktor mortalitas dini pada pasien HD sangat terbatas. Suatu model prediksi dapat menjadi alat bantu yang sederhana untuk mengetahui pasien yang berisiko tinggi sehingga pada akhirnya upaya pencegahan dapat dilakukan. Penelitian ini bertujuan untuk mengetahui insidens dan prediktor mortalitas 3 bulan pada pasien hemodialisis baru dan membuat suatu model prediksi.Metode. Penelitian dengan disain kohort retrospektif terhadap 246 pasien PGTA yang baru menjalani HD di Unit HD RSCM antara Januari 2011-Januari 2012. Dilakukan analisis chi-square untuk mendapatkan nilai OR (Odds Ratio) terhadap variabel usia, pembiayaan, jenis HD, akses pembuluh darah, anemia, hipoalbuminemia, kelainan EKG, kardiomegali, komorbid, waktu rujukan ke nefrologis, dan kepatuhan. Prediktor yang bermakna kemudian dimasukkan pada model regresi logistik untuk mendapatkan sistem skor.Hasil. Sebanyak 78 (31,7%) dari 246 pasien meninggal dalam 3 bulan pertama. Terdapat 5 variabel yang berhubungan dengan terjadinya mortalitas 3 bulan yaitu usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral. Skor prediksi untuk prediktor usia, hemoglobin, albumin serum, kelainan EKG, dan akses pembuluh darah berturut-turut sebesar 1, 3, 1, 3, 1. Jumlah skor kemudian dikategorikan menjadi risiko rendah (skor 0-3), sedang (skor 4-6), dan tinggi (skor 7-9). Tiap kelompok memiliki prediksi mortalitas 3 bulan berturut-turut sebesar 1,23%, 26,69%, dan 86,04%.Simpulan. Insidens mortalitas 3 bulan pada pasien HD baru sebesar 31,7%. Usia > 60 tahun, hemoglobin <8 g/dl, albumin serum <3,5 g/dl, kelainan EKG, dan akses femoral merupakan prediktor yang bermakna terhadap terjadinya mortalitas dalam 3 bulan pertama HD. Kata kunci. Hemodialisis, insidens, mortalitas 3 bulan, sistem skor.

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“…According to The U.S. Renal Data System (1), the adjusted first year mortality rate was 24.5% in 2004, which is ϳ17% higher than the mortality rate for dialysis patients in the second year and onward. During the first year, the risk of death rises to a peak at month 3 ( Figure 2), when the mortality rate has been estimated to be Ͼ40 deaths per 100 patient years (2). This increased mortality soon after the initiation of dialysis seems to be fairly universal, in that death risk is higher within the first 90 to 120 d regardless of age, gender, race (3), or country (personal communication with DOPPS, April 24, 2009).…”

mentioning

confidence: 99%

The “Right” of Passage

Wingard

Chan

Lazarus

et al. 2009

Clinical Journal of the American Society of Nephrology

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Mortality risk for dialysis patients is highest in the first year. We previously showed a 41% mortality benefit associated with a pilot case management program for incident hemodialysis patients (n ‫؍‬ 918). The RightStart Program (RSP) provided prompt medical management and self-management education and was recently expanded to more facilities. We conducted a matched cohort analysis to validate the expanded program's continued effectiveness. Death risk was reduced for RS patients (n ‫؍‬ 4308) versus matched controls (C; n ‫؍‬ 4308) by 34% (hazard ratio ‫؍‬ 0.66, P < 0.0001) at 120 d and 22% at 1 yr (hazard ratio ‫؍‬ 0.78, P < 0.0001). RS patients had lower hospitalization during the first year (RS ‫؍‬ 15.5 days per patient year versus C ‫؍‬ 16.9, P < 0.01). At 120 d, more RS patients achieved hemoglobin 11 to 12 g/dl (RS ‫؍‬ 22.4% versus C ‫؍‬ 19.7%, P < 0.01), eKt/V > 1.2 (RS ‫؍‬ 66% versus C ‫؍‬ 53.5%, P < 0.01), albumin > 4.0 g/dl (RS ‫؍‬ 26% versus C ‫؍‬ 22%, P < 0.01), and phosphorus 3.5 to 5.5 mg/dl (RS ‫؍‬ 52.4% versus C ‫؍‬ 45.4%). At 120 d, RS patients had a greater reduction in catheter use (RS ‫؍‬ 32% versus C ‫؍‬ 25%, P < 0.01) and more vitamin D orders (RS ‫؍‬ 60% versus C ‫؍‬ 55%, P < 0.01). Expansion of RS to a larger incident patient population results in significant reduction of morbidity and mortality associated with improvement of intermediate outcomes.

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Death during the first 90 days of dialysis: A case control study

Cited by 131 publications

References 11 publications

Early Outcomes among Those Initiating Chronic Dialysis in the United States

Early Outcomes among Those Initiating Chronic Dialysis in the United States

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

The “Right” of Passage

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