Improving Survival Rate of Korean Patients Initiating Dialysis

Abstract

PurposeThe aim of this study was to investigate whether the survival rate among Korean dialysis patients changed during the period between 2005 and 2008 in Korea.Materials and MethodsA total of 32357 patients who began dialysis between January 1, 2005 and December 31, 2008 were eligible for analysis. Baseline demographics, comorbidities, and mortality data were obtained from the database of the Health Insurance Review & Assessment Service.ResultsKaplan-Meier curves according to the year of dialysis initiation showed that the survival rate was significantly different (log-rank test, p=0.005), most notably among peritoneal dialysis (PD) patients (p<0.001), although not among hemodialysis (HD) patients (p=0.497). In multivariate analysis, however, patients initiating either HD or PD in 2008 also had a significantly lower risk of mortality compared to those who began dialysis in 2005. Subgroup survival analysis among patients initiating dialysis in 2008 revealed that the survival rate of PD patients was significantly higher than that of HD patients (p=0.001), and the survival benefit of PD over HD remained in non-diabetic patients aged less than 65 years after adjustment of covariates.ConclusionSurvival of Korean patients initiating dialysis from 2005 to 2008 has improved over time, particularly in PD patients. In addition, survival rates among patients initiating dialysis in 2008 were different according to patients' age and diabetes, thus we need to consider these factors when dialysis modality should be chosen.

Technique failure in Korean incident peritoneal dialysis patients: a national population-based study

“…In addition, when we compared the crude technique failure–free survival rates among PD patients according to the dialysis initiation year between 2005 and 2008, there were no significant changes across the years. Although the period was not enough to investigate sequential changes, the survival rate among Korean PD patients initiating dialysis significantly improved from 2005 to 2008, as previously reported [22]. Therefore, technique failure in PD persists as a major problem in Korea.…”

Comparison of peritoneal dialysis and hemodialysis as first renal replacement therapy in patients with end-stage renal disease and diabetes: a systematic review

“…The total numbers of diabetic patients included were 50,298 receiving PD and 71,532 receiving HD. Eight studies were from Asia [10,11,14,16,18,19,21,23], three were from Australia and New Zealand [15,20,22], three were from Europe [17,24,25], one was from North America [13], and one was from South Africa [12]. Several studies were based on the same registry or cohort databases, such [15,20,22], the Korean Health Insurance Review and Assessment Service (HIRA) database [10,19,21,23], and the National Health Insurance Research Database (NHIRD) of Taiwan [11,16].…”

“…Fifteen studies [10,[12][13][14][15][16][17][18][19][20][21][22][23][24][25] investigated all-cause mortality among diabetic patients undergoing PD and HD (Table 3). Several studies investigated differences in survival between diabetic and non-diabetic patients in subgroup analyses.…”

“…Differences in mortality favoring HD were observed in nine studies [10,12,13,15,16,19,[21][22][23]. Marshall et al [15] reported an HR of 1.17 (95% CI 1.11-1.25) for death among patients receiving incident PD relative to those receiving incident HD, based on ANZDATA data.…”

Introduction to the Medical Research Using National Health Insurance Claims Database

“…In spite of limitations, researchers can easily use these databases for their research now than ever, and the results may be utilized not only to expand the academic knowledge but also to influence the determination of national healthcare policy. CKD prevalence in adults 10.6% [7] Annual growth rate in number of CKD patients (2006-2010) 8.2% [8] Number of treating CKD patients 0.16 million [9] Estimated number of treating CKD patients 3.7% -CKD as a mortality cause 12/100,000 PY [6] Total medical cost of CKD in 2014 KRW1.4 billion [9] Annual growth rate in cost of CKD patients (2006-2010) 10.2% [8] Ratio of annual medical cost of CKD stage 3, 4, and 5 over that of hypertension 3.0, 4.9, and 21.1 [6] Crude all-cause mortality rate of ESRD patients 116/1,000 PY [10] Overall hazard ratio of PD over HD 1.20 [4] Hazard ratio of PD survival in 2008 vs. 2005 0.75 [11] Standard mortality ratio of ESRD patients compared to the general population 10.9 [12] Total medical cost of HD in 2013 KRW1.6 billion [13] Annual growth rate in cost of HD patients (2009-2013) 6.4% [13] Ratio of annual medical cost of HD and PD over that of hypertension 86.7 and 65.1 [6] CKD, chronic kidney disease; ESRD, end-stage renal disease; PY, patient-years; PD, peritoneal dialysis; HD, hemodialysis. …”