Worldwide Increase in Mortality Soon After Start of Dialysis

Data from many different countries show that the first few months after the start of dialysis are a high-risk period for mortality, reports a study in Kidney International.

The researchers analyzed data on nearly 87,000 patients from 11 countries, submitted to the Dialysis Outcomes and Practice Patterns Study (DOPPS). All-cause mortality in the early period within 120 days after the start of dialysis was compared with the intermediate period (121 through 365 days) and late period (after 365 days). Analyses were adjusted for age, sex, race, and presence of diabetes.

The rate of death per 100 patient-years was 26.7 during the early period after the start of dialysis, decreasing to 16.9 in the intermediate period and 13.7 in the late period. All 11 countries had higher mortality in the early period than in the intermediate period. Adjusted hazard ratios (HRs) for the early period versus the intermediate period varied considerably: 3.1 in Japan; 1.6 to 1.8 in Australia/New Zealand, Belgium, and Italy; 1.3 to 1.5 in Canada, France, Germany, Sweden, and the United States; and 1.2 in the United Kingdom. For the late period versus the intermediate period, the HRs were closer to 1.

The risk of death during the early period was higher for older patients than for younger patients (HR 1.59 versus 1.08), for female patients than for male patients (HR 1.62 versus 1.46), and for patients without diabetes as the primary cause of ESRD (HR 1.62 versus 1.39). During all periods, most countries had lower mortality than did the United States.

Previous studies have reported increased mortality early after the beginning of dialysis. This study suggests a higher risk of death during the first 120 days in patients receiving dialysis in all countries participating in the DOPPS. Early mortality differs between countries; the United States is on the higher end of the range. The investigators conclude, “Efforts to improve outcomes should focus on the transition period and the first few months of dialysis” [Robinson BM, et al. Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney Int 2014; 85:158–165].