| Early outcomes among those initiating chronic dialysis in the United States. | |
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MedLine Citation:
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PMID: 21959599 Owner: NLM Status: MEDLINE |
Abstract/OtherAbstract:
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BACKGROUND 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 = 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, >300,000 patients initiated chronic dialysis and were followed for >35 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%. CONCLUSIONS: The 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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Authors:
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Kevin E Chan; Frank W Maddux; Nina Tolkoff-Rubin; S Ananth Karumanchi; Ravi Thadhani; Raymond M Hakim |
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Publication Detail:
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Type: Journal Article Date: 2011-09-29 |
Journal Detail:
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Title: Clinical journal of the American Society of Nephrology : CJASN Volume: 6 ISSN: 1555-905X ISO Abbreviation: Clin J Am Soc Nephrol Publication Date: 2011 Nov |
Date Detail:
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Created Date: 2011-11-09 Completed Date: 2012-02-29 Revised Date: 2013-04-01 |
Medline Journal Info:
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Nlm Unique ID: 101271570 Medline TA: Clin J Am Soc Nephrol Country: United States |
Other Details:
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Languages: eng Pagination: 2642-9 Citation Subset: IM |
Affiliation:
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Fresenius Medical Care North America, Waltham, Massachusetts, USA. |
Export Citation:
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| MeSH Terms | |
Descriptor/Qualifier:
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Aged Arteriovenous Shunt, Surgical / adverse effects Blood Vessel Prosthesis Implantation / adverse effects Catheterization, Central Venous / adverse effects Female Hospitalization Humans Kidney Failure, Chronic / mortality, therapy* Male Middle Aged Peritoneal Dialysis / adverse effects*, mortality Renal Dialysis / adverse effects*, mortality Risk Assessment Risk Factors Time Factors Treatment Outcome United States / epidemiology |
| Comments/Corrections | |
Comment In:
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Clin J Am Soc Nephrol. 2011 Nov;6(11):2561-3
[PMID:
21980180
]
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From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine
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