Abstract

BackgroundAlthough dialysis is typically started in an effort to prolong survival, mortality is reportedly high in the first few months. However, it remains unclear whether this is true in Japanese patients who tend to have a better prognosis than other ethnicities, and if health conditions such as functional status (FS) at initiation of dialysis influence prognosis.MethodsWe investigated the epidemiology of early death and its association with FS using Japanese national registry data in 2007, which included 35,415 patients on incident dialysis and 7,664 with FS data. The main outcome was early death, defined as death within 3 months after initiation of hemodialysis (HD). The main predictor was FS at initiation of HD. Levels of functional disability were categorized as follows: severe (bedridden), moderate (overt difficulties in exerting basic activities of daily living), or mild/none (none or some functional disabilities).ResultsEarly death remained relatively common, especially among elderly patients (overall: 7.1%; those aged ≥80 years: 15.8%). Severely and even only a moderately impaired FS were significantly associated with early death after starting dialysis (adjusted risk ratios: 3.93 and 2.38, respectively). The incidence of early death in those with impaired FS increased with age (36.5% in those with severely impaired FS and aged ≥80 years).ConclusionsEarly death after starting dialysis was relatively common, especially among the elderly, even in Japanese patients. Further, early death was significantly associated with impaired FS at initiation of HD.

Highlights

  • Dialysis is initiated in patients with end-stage kidney disease (ESKD) primarily to prolong survival; mortality in the first few months after starting dialysis is reportedly higher than later mortality [1]

  • We investigated the epidemiology of early death and its association with functional status (FS) using Japanese national registry data in 2007, which included 35,415 patients on incident dialysis and 7,664 with FS data

  • And even only a moderately impaired FS were significantly associated with early death after starting dialysis

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Summary

Introduction

Dialysis is initiated in patients with end-stage kidney disease (ESKD) primarily to prolong survival; mortality in the first few months after starting dialysis is reportedly higher than later mortality [1]. A recent analysis in Western countries found that the probability of early death (within 3 months after initiation of dialysis) ranged from 5.6 to 8.6% [2], indicating that many patients do not survive long enough to benefit from dialysis. Dialysis is typically started in an effort to prolong survival, mortality is reportedly high in the first few months It remains unclear whether this is true in Japanese patients who tend to have a better prognosis than other ethnicities, and if health conditions such as functional status (FS) at initiation of dialysis influence prognosis

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