Mortality trends among Japanese dialysis patients, 1988–2013: a joinpoint regression analysis

Wakasugi, Minako; Kazama, Junichiro James; Narita, Ichiei

doi:10.1093/ndt/gfw249

Cited by 46 publications

(37 citation statements)

References 33 publications

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“…The number of ESRD patients on HD is increasing in many countries because the prognosis for these patients has improved as a result of medical progress and changes in trends regarding cause of death [36–38]. The incidence of cardiovascular disease, the main cause of death for hemodialysis patients, has decreased, but the incidences of other diseases, such as infection and malignant disease, have not [38].…”

Section: Resultsmentioning

confidence: 99%

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Recommendations for perioperative management of lung cancer patients with comorbidities

Tsubochi

Shibano

Endo

2017

Gen Thorac Cardiovasc Surg

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ObjectivesTo improve surgical outcomes, clinicians must provide optimal perioperative care for comorbidities identified as significant factors in risk models for patients undergoing lung cancer surgery.MethodsWe reviewed trends in perioperative care for idiopathic pulmonary fibrosis, cardiovascular diseases, and end-stage renal diseases in patients undergoing lung cancer surgery, as large clinical databases indicate that these comorbidities are significant risk factors for lung cancer surgery. Articles identified by keyword searches were included in the analysis.ResultsSignificant predictive factors for acute exacerbation of idiopathic pulmonary fibrosis were identified. However, no effective perioperative care was identified for prevention of acute exacerbation of interstitial pneumonia. The timing of coronary revascularization and antithrombotic management for cardiovascular diseases are subjects of ongoing research, and acid–base balance is essential in the management of hemodialysis patients with end-stage renal diseases.ConclusionsTo improve surgical outcomes for lung cancer patients, future studies should continue to study optimal perioperative management of comorbidities.

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Section: Resultsmentioning

confidence: 99%

“…The incidence of cardiovascular disease, the main cause of death for hemodialysis patients, has decreased, but the incidences of other diseases, such as infection and malignant disease, have not [38]. The probability of treatment has increased during the past decade because of the better prognosis of ESRD patients.…”

Section: Resultsmentioning

confidence: 99%

Recommendations for perioperative management of lung cancer patients with comorbidities

Tsubochi

Shibano

Endo

2017

Gen Thorac Cardiovasc Surg

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“…Additionally, cardiac failure because of CAD remains the leading cause of mortality in Japanese dialysis patients. 2,3 Therefore, appropriate management of CAD including PCI procedures is vitally important for dialysis patients.…”

Section: Discussionmentioning

confidence: 99%

An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

Numasawa

Inohara

Ishii

et al. 2018

Cathet Cardio Intervent

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Objectives This study sought to provide an overview of percutaneous coronary intervention (PCI) in dialysis patients from a Japanese nationwide registry. Background Little is known about dialysis patients undergoing PCI because few are enrolled in clinical trials. Methods We analyzed 624,900 PCI cases including 41,384 dialysis patients (6.6%) from 1,017 Japanese hospitals between 2014 and 2016. We investigated differences in characteristics and in‐hospital outcomes between dialysis and nondialysis patients, and assessed factors associated with an increased risk of adverse outcomes. Results Dialysis patients had more comorbidities than nondialysis patients and higher rates of complications including in‐hospital mortality (3.3% vs. 1.5%, respectively, in the acute coronary syndrome [ACS] cohort, 0.2% vs. 0.1% in the non‐ACS cohort) and bleeding complications requiring blood transfusion (1.1% vs. 0.4% in ACS, 0.5% vs. 0.2% in non‐ACS). Dialysis was significantly associated with an increased risk of in‐hospital mortality (odds ratio [OR]: 1.42, 95% confidence interval [CI]: 1.24–1.62 in ACS, OR: 2.25, 95% CI: 1.66–3.05 in non‐ACS) and bleeding (OR: 1.60, 95% CI: 1.30–1.96 in ACS, OR: 1.55, 95% CI: 1.27–1.88 in non‐ACS). For dialysis patients, age, acute heart failure, and cardiogenic shock were associated with an increased risk of in‐hospital mortality in the ACS cohort, whereas age, female gender, and history of heart failure were associated with higher in‐hospital mortality in the non‐ACS cohort. Conclusions PCI was widely performed for dialysis patients with either ACS or non‐ACS in Japan. Dialysis patients had a greater risk of adverse outcomes than nondialysis patients after PCI.

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“…While the authors cautioned that the higher mortality rate with the frequent nocturnal group in the long term needed to be interpreted judiciously in view of the unusually low mortality rate for patients assigned to the conventional group, this is not an uncommon occurrence in many Asian countries such as Japan, where age-standardized mortality rate on HD could be as low as 97.0 per 1000 patient-years. 20 In addition, the FHN daily trial also demonstrated that frequent HD was associated with the need to undergo interventions related to vascular access, especially in the analysis of the time to the first intervention (HR 1.71, 95% CI 1.08-2.73). There was also a trend, though not statistically significant because of the small sample size, towards increased vascular access events in the nocturnal arm of the FHN nocturnal trial, which raised the concerns of vascular access dysfunction as a trade-off for more frequent HD.…”

Section: Frequent Haemodialysismentioning

confidence: 99%

“…First, frequent HD does not appear to be as innocuous as originally perceived, and perhaps increasing the duration of HD is not without harm as seen in the FHN nocturnal trial. While the authors cautioned that the higher mortality rate with the frequent nocturnal group in the long term needed to be interpreted judiciously in view of the unusually low mortality rate for patients assigned to the conventional group, this is not an uncommon occurrence in many Asian countries such as Japan, where age‐standardized mortality rate on HD could be as low as 97.0 per 1000 patient‐years . In addition, the FHN daily trial also demonstrated that frequent HD was associated with the need to undergo interventions related to vascular access, especially in the analysis of the time to the first intervention (HR 1.71, 95% CI 1.08–2.73).…”

Section: Frequent Haemodialysismentioning

confidence: 99%

Perspectives in renal replacement therapy: Haemodialysis

Liew

2018

Nephrology

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Haemodialysis (HD) was the first procedure that had demonstrated the ability to partially replace renal function, and became the most widely utilized treatment for patients with end‐stage renal disease (ESRD). In a great majority of countries around the world, conventional in‐centre HD had become the predominant renal replacement therapy, being touted as able to achieve better solute clearance and more successful in attaining euvolemia than patients on peritoneal dialysis. This is despite the antecedent hemodynamic risks, more rapid loss of residual renal function, greater infectious perils, excessive erythropoietin requirements and higher infrastructure costs. In addition, quality of life had been suggested to be worse among patients on HD, though this had been challenged repeatedly. Consequently, the concept of integrated ESRD care over the last few decades had placed HD, as a complementary rather than a competitive treatment modality to the entire armamentarium of renal replacement therapies. Incorporating HD as part of integrated care into health‐care policies and national resource planning will become an essential strategy in improving access and outcome to care among the ESRD population. The improvement in technologies and innovation in prescription had brought forth enhanced dialyzer membrane and machine upgrades, and expanded modalities including more frequent HD and haemodiafiltration. While boasting of controversial improvement in outcomes, many of these therapies remain expensive and insurmountable for widespread utility in many countries. In addition, the results of these new technologies had been conflicting across studies, with some even suggesting that they could be detrimental. Therefore, judicial consideration has to be undertaken to appropriate their use in clinical practice.

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Mortality trends among Japanese dialysis patients, 1988–2013: a joinpoint regression analysis

Abstract: Significant progress has been made, particularly with regard to the decrease in age-standardized mortality rates. The risk of cardiovascular death has decreased, while the risk of death from infection has remained unchanged for 25 years.

Cited by 46 publications

References 33 publications

Recommendations for perioperative management of lung cancer patients with comorbidities

Recommendations for perioperative management of lung cancer patients with comorbidities

An overview of percutaneous coronary intervention in dialysis patients: Insights from a Japanese nationwide registry

Perspectives in renal replacement therapy: Haemodialysis

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