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Survival in Patients Treated by Long-term Dialysis Compared With the General Population

Published:February 24, 2012DOI:https://doi.org/10.1053/j.ajkd.2011.12.023

      Background

      Relative survival, a methodology previously used in epidemiologic studies of cancer, compares the observed survival of a patient cohort with expected survival derived from general population life tables. We examined relative survival in patients treated by long-term dialysis in the Italian Dialysis and Transplantation Registry in order to determine the prognosis of dialysis patients.

      Study Design

      Cohort study drawn from a registry.

      Setting & Participants

      Patients enrolled in the Italian Dialysis and Transplantation Registry.

      Factors

      Sex, age, primary kidney disease, renal replacement therapy modality, and main comorbid conditions.

      Outcomes

      Death from any cause.

      Measurements

      Relative survival ratio (the ratio of observed survival in the population of interest to the survival expected given the age- and period-specific mortality of the general population) and excess mortality rate (difference between observed and expected mortality rates).

      Results

      In January 2000 to December 2008, a total of 27,642 patients were included. The 5-year relative survival estimate was 55.6% (95% CI, 54.7%-56.5%). The excess mortality rate showed a peak at 3 months (21 deaths/100 patient-years), then decreased, becoming constant from the end of year 1 to year 8, with leveling off at about 10 deaths/100 patient-years. Older age, systemic diseases, and diabetes showed the strongest association with excess mortality. Peritoneal dialysis was associated with a lower relative excess risk in only the first year of treatment.

      Limitations

      The patient cohort comprises about half the Italian patients beginning dialysis therapy in the period.

      Conclusions

      This study highlights the applicability of relative survival methods in dialysis patients. This measure allows estimation of disease prognosis and severity comparisons among chronic diseases. The excess mortality rate appears to be a more sensitive and informative measure than the simple proportion of survivors.

      Index Words

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