Survival Rate Of Dialysis Patients Research Articles

Switching from high-flux dialysis to hemodiafiltration: Cost-consequences for patients, providers, and payers.

Hemodiafiltration (HDF) achieves a more efficient reduction of the uremic toxic load compared to standard high-flux hemodialysis (HF-HD) by virtue of the combined diffusive and convective clearances of a broad spectrum of uremic retention solutes. Clinical trials and registry data suggest that HDF improves patient outcomes. Despite the acknowledged need to improve survival rates of dialysis patients and the survival benefit HDF offers, there is little to no utilization in some countries (such as the US) in prescribing HDF to their patients. In this analysis, we present the healthcare value-based case for HDF (relative to HF-HD) from the patient, provider, and payor perspectives. The improved survival and reduced morbidity observed in studies conducted outside the US, as well as the reduced hospitalization, are attractive for each stakeholder. We also consider the potential barriers to greater utilization of HDF therapies, including unfounded concerns regarding additional costs of HDF, e.g., for the preparation and microbial testing of quality of substitution fluids. Ultrapure fluids are easily attainable and prepared from dialysis fluids using established "online" (OL) technologies. OL-HDF has matured to a level whereby little additional effort is required to safely implement it as all modern machine systems are today equipped with the OL-HDF functionality. Countries already convinced of the advantages of HF-HD are thus well positioned to make the transition to OL-HDF to achieve further clinical and associated economic benefits. Healthcare systems struggling to cope with the increasing demand for HD therapies would therefore, like patients, be beneficiaries in the long term with increased usage of OL-HDF for end stage kidney disease patients.

Why should we focus on high-volume hemodiafiltration?

Though noticeable technological advances related to hemodialysis (HD) have been made, unfortunately, the survival rate of dialysis patients has yet to improve significantly. However, recent research findings reveal that online hemodiafiltration (HDF) significantly improves patient survival in comparison to conventional HD. Accordingly, the number of patients receiving online HDF is increasing. Although the mechanism driving the benefit has not yet been fully elucidated, survival advantages are mainly related to the lowering of cardiovascular mortality. High cardiovascular mortality among HD patients is seemingly attributable to the cardiovascular changes that occur in response to renal dysfunction and the HD-induced myocardial stress and injury, and online HDF appears to improve such secondary cardiovascular changes. Interestingly, patient survival improves only if the convection volume is supplied sufficiently over a certain level during online HDF treatment. In other words, survival improvement from online HDF is related to convection volume. Therefore, there is a growing interest in high-volume HDF in terms of improving the survival rate. The survival improvement will require a minimum convection volume of 23 L or more per 4-hour session for postdilution HDF. To obtain an optimal high convection volume in online HDF, several factors, such as the treatment time, blood flow rate, filtration fraction, and dialyzer, need to be considered. High-volume HDF can be performed easily and safely in routine clinical practice. Therefore, when the required equipment is available, performing high-volume HDF will help to improve the survival rate of dialysis patients.

MO667SWITCHING TO ONE-TIME USE OF DIALYZERS FOR HEMODIALYSIS: A ONE-YEAR SURVIVAL ANALYSIS IN TASHKENT

Abstract Background and Aims Until recently, for various reasons in Uzbekistan, it was often necessary to reuse disposable dialyzers for hemodialysis procedures. On June 13, 2018, a Resolution of the President of the Republic of Uzbekistan was issued on measures to improve the effectiveness of the provision of nephrological and dialysis care to the population of our country. Thanks to this, funding and provision of all nephrological and dialysis centers have sharply increased, as well as the country's transplant service has been re-established. Since the end of 2018, dialyzers are used exclusively once in all dialysis centers in our country. We were interested in comparatively studying the survival rate of dialysis patients during one year, before and after the transition to the use of single dialyzers in our center. Method We conducted a prospective observation of 120 (63 men and 57 women) patients with end-stage CKD and receiving programmed hemodialysis at our dialysis center in Tashkent. Our observation took place for 2 years: from the beginning of 2018 to the end of 2019. The study took place in 2 stages, 1 year each: at the first stage, within 1 year (from the beginning to the end of 2018), the survival rate of the observed patients receiving hemodialysis with repeated use of disposable dialyzers was assessed. At the second stage (after the transition to one-time use of dialyzers throughout the country), also for 1 year (from the beginning to the end of 2019), all the patients we observed received hemodialysis sessions with a single use of dialyzers. All patients were diagnosed with end-stage CKD. The average age of the patients was 49.7 ± 14.1 years. The average duration of hemodialysis was 29.4 (6-252) months. All patients underwent hemodialysis sessions with identical apparatus and dialyzers of the same manufacturer. The primary diseases in the patients were glomerulonephritis (n = 44, 36.7%), type 2 diabetes (n = 38, 31.7%), urolithiasis (n = 13, 10.8%), polycystic kidney disease (n = 7, 5.8%), lupus (n = 5, 4.2%) and others (n = 13, 10.8%). Survival was assessed using the Kaplan-Meier method, the confidence interval was determined by Greenwood. Results During the entire period (24 months) of observation, out of 120 patients, 26.7% (n = 32) patients died, 73.3% (n = 88) survived (of which 10 patients underwent kidney transplantation). We will assess the survival rate depending on the periods of dialyzer use. During 1 year of follow-up (the period of repeated use of disposable dialyzers), 19.2% (n = 23) patients died, 80.8% (n = 97) survived and continued to receive hemodialysis, of which 2 (1.7%) patients underwent a kidney transplant and knocked out of observation. The main cause of death was cardiovascular complications (sudden cardiac death, myocardial infarction, stroke, etc.), as a result of which 69.6% (n = 16) of patients died. The survival rate for 1 year was S (t) = 0.815 [95% CI, 0.745-0.885]. Over the next 12 months (single use period), out of 95 patients continuing to receive hemodialysis, 9.5% (n = 9) patients died, 82.1% (n = 78) patients survived. 8.4% (n = 8) of the observed patients underwent kidney transplantation. 55.6% (n = 5) of all deceased patients died from cardiovascular complications. The survival rate at 1 year was S (t) = 0.901 [95% CI, 0.839-0.962]. Conclusion Compliance with the standards for hemodialysis, in particular, the single use of disposable dialyzers for hemodialysis sessions leads to a decrease in the lethality of dialysis patients. The transition from multiple to single use of disposable dialyzers in one dialysis center in Uzbekistan showed a significant increase in survival by 10.6%.

Calculation of expected remaining lifetime of dialysis patients in Japan

BackgroundThe expected remaining lifetime of dialysis patients in Japan was only reported in 2003 and has not been reported thereafter. From 2003 to the present, several new therapeutic agents have been introduced. These events may have improved outcomes for dialysis patients. Thus, expected remaining lifetime of dialysis patients in Japan was newly calculated in 2015.MethodsThe Japanese Society for Dialysis Therapy Renal Data Registry database was used for analyses. From this database, the following three indexes were compiled: the number of surviving dialysis patients (198,125 males and 111,962 females) at the end of 2014 and the number of surviving (179,649 males and 101,758 females) and dead (18,044 males and 111,417 females) patients at the end of 2015. Based on these values, expected remaining lifetime at 1-year increment was calculated using the life table method.ResultsExcerpts of the calculated expected remaining lifetimes of patients aged 60 years were as follows: 11.9 years for males and 14.1 years for females. These expected remaining lifetimes were 1.1 to 1.2 times as compared with those in 2003. Meanwhile, expected remaining lifetime of diabetic patients was 10.8 years for males and 12.5 years for females and that of nondiabetic patients was 13.0 years for males and 15.0 years for females.ConclusionExpected remaining lifetime of dialysis patients in Japan in 2015 was 10–20% longer than that in 2003. These results suggest that advances in dialysis technologies during this 12-year period improved the survival rate of dialysis patients.

FACTORS ASSOCIATED WITH INTRADIALYTIC HYPOTENSION IN HEMODIALYSIS PATIENTS AND WAYS OF ITS CORRECTION. CLINIC EXPERIENCE

Results of studies in recent years show a worse survival rate of dialysis patients who have frequent episodes intradialytic hypotension (IDH), as opposed patients without IDH.
 The purpose of this quality improvement project was to study the factors associated with intradialytic hypotension in these patients and institute appropriate measures to mitigate this issue.
 Patients and methods. In our clinic, we identified that 14.3% of dialysis patients experienced a decrease in their systolic blood pressure (SBP) to below 80 during dialysis.
 Results. The results were studied for 3 months. We found that 57.1% of patients experienced an improvement in their blood pressure profile over the period of the study.
 Conclusions. Factors associated with IDH are hypocalcemia, heart failure with systolic dysfunction, increase mterdialytic body weight over 2.5 kg and hospitalizations more than 2 times/year. Suggesting that simple changes to dialysis prescription can result in a significant reduction in the incidence of IDH.

The present status of and perspectives on home hemodialysis therapy in Japan.

Home hemodialysis (HHD) is one of the best choices for improving the quality of life and survival rate of dialysis patients because it can lead to longer and more frequent dialysis programs to aid in achieving adequate dialysis. There were 461 dialysis patients treated with HHD as of the end of 2013 in Japan, comprising only 0.1% of all dialysis patients in this country. Although this is a very small expansion rate, the number of HHD patients has been rapidly increasing in recent years. The Japanese Society for Home Hemodialysis was established in 1998 and formed the following 3 working groups to survey various problems underlying current HHD: Patient Registry, Supply and Waste, and Self-pay Burden. In order to achieve a successful HHD program in Japan, there are several issues to be resolved, including the development of standard recruitment and education programs, optimization of the composition of dialysis fluid, sufficient reimbursement for HHD, and the establishment of a business model for HHD similar to that for peritoneal dialysis.

Estimation of dialysis patients’ survival through combined approach of small molecule uremic markers

Survival rate of dialysis patients is still alarmingly low and various factors may have in it an important role. The purpose of this study was to observe the relationship between the survival of dialysis patients and the serum level of urea, creatinine, and uric acid (UA). Serum urea and creatinine concentrations may express patient's nutritional status and muscle mass, and high UA value may refer to higher risk for cardiovascular events. The idea of combining the concentrations and removal of urea and UA into a single model for predicting the patient's outcome is introduced. The study included 33 hemodialysis patients from Linkoping, Sweden and 10 from Tallinn, Estonia. Kaplan-Meier analysis was used for survival analysis. Logistic and Cox regression analysis was applied to create models for predicting patients' three-year survival. It was observed that higher serum UA is significantly related to poor survival in dialysis patients (p = 0.026). A reverse effect was observed in case of urea (p = 0.095). The level of creatinine was not related to survival (p = 0.905). The best logistic regression model for predicting patients' outcome included both UA and urea based parameters (Chi Square 21.0, p = 0.0001). Survival of dialysis patients seems to be determined by a set of causal factors and combined models may have a predictive relevance. A possibility for automatic online monitoring of small molecule uremic markers is proposed. Since the number of participating patients was small, larger studies including more patients and testing the models in independent validation cohort is the future goal.

Mineral Metabolic Abnormalities and Mortality in Dialysis Patients

The survival rate of dialysis patients, as determined by risk factors such as hypertension, nutritional status, and chronic inflammation, is lower than that of the general population. In addition, disorders of bone mineral metabolism are independently related to mortality and morbidity associated with cardiovascular disease and fracture in dialysis patients. Hyperphosphatemia is an important risk factor of, not only secondary hyperparathyroidism, but also cardiovascular disease. On the other hand, the risk of death reportedly increases with an increase in adjusted serum calcium level, while calcium levels below the recommended target are not associated with a worsened outcome. Thus, the significance of target levels of serum calcium in dialysis patients is debatable. The consensus on determining optimal parathyroid function in dialysis patients, however, is yet to be established. Therefore, the contribution of phosphorus and calcium levels to prognosis is perhaps more significant. Elevated fibroblast growth factor 23 levels have also been shown to be associated with cardiovascular events and death. In this review, we examine the associations between mineral metabolic abnormalities including serum phosphorus, calcium, and parathyroid hormone and mortality in dialysis patients.

The Crossroad of RAAS Modulation, Inflammation, and Oxidative Stress in Dialysis Patients

After four decades of fully reimbursed chronic dialysis therapy in the United States under the justification of lifesaving treatment, the survival rate of dialysis patients remains worse than many fatal cancers.[1][1] Most recorded causes of mortality on death certificates are cardiovascular or

Characteristics of 20‐Year Survivors Undergoing Maintenance Hemodialysis

Hemodialysis techniques have improved remarkably in recent decades and the number of long-term survivors among patients with end-stage renal disease has increased. The mortality rate of hemodialysis patients has been reported to be low in Japan. However, the long-term survival rate of dialysis patients is still low: 23.6% for 15 years and 17.4% for 20 years, even in Japan, and background information on patients undergoing hemodialysis therapy for more than 20 years is scarce in this country. In the present study, we investigated the characteristics of 20-year survivors undergoing maintenance hemodialysis at our medical center. We compared the characteristics of hemodialysis patients who had survived for more than 20 years after the initiation of hemodialysis with those of patients who started hemodialysis at the same time and had already died. No patient among those who were still alive had diabetes mellitus while 15% of patients who had died had diabetes mellitus at the time of initiation of hemodialysis. Age, cardiothoracic ratio, and serum levels of total cholesterol and triglyceride 6 months after the initiation of hemodialysis, as well as decreases in body weight per year were significantly lower in those who had survived than in those who had died. These results suggest that long-term hemodialysis survivors are characterized by (i) initiation of hemodialysis at a young age (ii) being free of diabetes mellitus (iii) a well-controlled cardiothoracic ratio (iv) small successive change in body weight, and (v) being free of hypercholesterolemia and hypertriglyceridemia.

Primary Urothelial Carcinoma of the Upper Urinary Tract in Dialysis Patients with 5-year Follow-up

In this study, we assessed the clinical and pathological characteristics of urothelial cancers of the upper urinary tract (UUT) in patient under dialysis and evaluated the efficacy and complications of surgical management of the disease. A total of 70 dialysis patients with primary urothelial carcinoma (UC) of the UUT were identified with 5-year follow-up after surgery (61-122 months). Potential factors were analysed to determine the risk factors of subsequent tumours and unfavourable prognostic factors of overall survival. Incidence of urothelial tumours and overall survival of 7503 dialysis patients were also evaluated. The incidence of primary UC of the UUT in dialysis patients in Taiwan was 0.93%. The 2-year and 5-year overall survival rates of dialysis patients with primary UC of the UUT were 74.3% and 42.9%, respectively. Subsequent bladder tumours and contralateral UUT tumours developed in 52.6% and 37.9% patients, respectively. No significant risk factor could be identified to predict subsequent tumours in dialysis patients. Pathological stage (P = 0.021) and grade (P < 0.001) were the unfavourable prognostic factors in the log-rank test. No significant difference was observed in perioperative mortality and overall survival between patients receiving one-stage nephroureterectomy and those receiving two-stage bilateral nephroureterectomy; however, the cystectomy procedure increased perioperative mortality according to the chi(2) test (P = 0.042). Closely monitoring the residual urinary tracts after nephroureterectomy in dialysis patients with primary UC of the UUT should be performed. There is no statistical difference for overall survival between one-stage and two-stage bilateral nephroureterectomy.

Recurrences and Infections During Continuous Immunosuppressive Therapy After Beginning Dialysis in ANCA-Associated Vasculitis

Approximately 20% of patients with antineutrophil cytoplasm antibody-associated systemic vasculitis (AASV) develop end-stage renal failure (ESRF). It is not clear whether continuation of immunosuppression, with its associated risks, is beneficial because relapse rates after the development of ESRF are reported to be low. Case series. Single tertiary-care referral center. 46 patients with AASV who developed ESRF from 1971 to 2004. Treatment, relapse rates before and after dialysis therapy, patient outcome after dialysis therapy, and infection (defined as admission to hospital or intravenous antibiotics) were recorded. Patients with AASV on dialysis therapy had 1- and 5-year survival rates of 82% and 55%, equivalent to current 1- and 5-year survival rates of dialysis patients reported by the UK renal registry, respectively. Infection rates in patients with ESRF were high in those with AASV on dialysis therapy; 106 events in 35 patients (dialysis patients with AASV, 0.89 infections/patient-year; confidence interval [CI], 0.74 to 1.08). Eight of 9 patients who died of infection were receiving immunosuppressive therapy. No patient died of active disease. Relapse rates after dialysis commencement were less than those predialysis (6 relapses in 4 patients; 0.05 relapses/patient-year postdialysis; CI, 0.02 to 0.1 compared with 18 relapses in 11 patients; 0.13 relapses/patient-year predialysis; CI, 0.07 to 0.19). This is a retrospective study spread over 3 decades with no control group. Patients with AASV and ESRF are less likely to experience relapse than before dialysis therapy. Patients with AASV on dialysis therapy have a high rate of infection. These results may not be applicable to patients with pulmonary involvement.

High-dose parenteral iron sucrose depresses neutrophil intracellular killing capacity

Iron is essential for the formation of hemoglobin. During long-term treatment with human recombinant erythropoietin (rhEPO), the majority of end-stage renal disease (ESRD) patients will not respond adequately to rhEPO unless substituted with intravenous iron. However, concern exists about possible detrimental effects of parenteral iron on cellular host defense and iron-mediated increments of oxidative stress. We analyzed phagocytic functions of polymorphonuclear leukocytes (PMN) isolated from 20 ESRD patients on peritoneal dialysis in response to 300 mg of iron sucrose or placebo administered intravenously over two hours in a randomized, double-blind manner. We evaluated Fc gamma R-dependent phagocytosis and killing (primary outcome variable) of opsonized Escherichia coli, Fc gamma R-dependent oxidative burst capacity, and complement receptor 3 (CR3, Mac1, CD11b/CD18)/tumor necrosis factor alpha (TNFalpha)-mediated release of bactericidal lactoferrin before, during, one hour, and two days after administration. The absolute count and the percentage of E. coli killed by PMN of iron sucrose-treated peritoneal dialysis patients decreased significantly over time in comparison to placebo-treated patients (F = 3.48, df = 4, P = 0.008; F = 3.99, df = 4, P = 0.006, respectively). All secondary outcome variables were not different between both groups over time. Killing capacity of PMN isolated from ESRD patients decreases in response to high-dose parenteral iron sucrose, possibly in part explaining reported higher hospitalization rates and lower survival rates of dialysis patients receiving frequent and high-dose parenteral iron.

Cost-effectiveness analysis of dialysis and kidney transplants in Japan.

Although kidney transplantation is considered to be more desirable than dialysis in terms of cost-effectiveness and patients' quality of life, there have been very few cases of kidney transplants in Japan. This study was conducted to compare the cost-effectiveness of dialysis and kidney transplants using Disability-Adjusted Life Years (DALYs) as an indicator of effectiveness. Most data necessary for the DALYs analysis were obtained from publications. The disability weights for dialysis patients and kidney transplant patients were estimated based on a questionnaire e-mailed to medical officials of the Japanese Government. Expected duration of treatment was estimated from the survival rates of dialysis patients and the graft-survival rates of transplant patients using the Weibull model method. The cost of dialysis and living-related donor (LRD) transplant included only medical expenditures and neglected all other costs, and the cost of cadaveric donor (CAD) transplant included the budget for organ procurement and distribution in addition to medical expenditures. The analysis showed that dialysis averted 138,019 DALYs/year, living-related donor transplant averted 5,740 DALYs/year, and CAD transplant averted 1,892 DALYs/year. The cost-effectiveness ratio (C-E ratio) was 9,546 thousand yen/DALY for dialysis, 1,809 thousand yen/DALY for LRD transplant, and 2,322 thousand yen/DALY for CAD transplant. These results could be used for the decision making of the Government on what resources should be allocated to the promotion of kidney transplantation. Also, the methodology used in this study can be applied to cost-effectiveness analysis of other organ transplants.

Report on management of renale failure in Europe, XXVI, 1995. Rare diseases in renal replacement therapy in the ERA-EDTA Registry.

The proportion of centres returning the ERA-EDTA Registry questionnaires has decreased considerably in recent years. Demographic information, based on the response rate of centres in 1994 (44%), does not allow reasonable projections for management of renal failure in Europe. To encourage the participation of non-responding centres, the timing was right to show the powerful impact of the ERA-EDTA Registry as a supra-national registry, by studying patients in renal replacement therapy (RRT) suffering from rare diseases. Four such diseases, Fabry's disease, nephropathy due to cyclosporin (CsA), nephropathy due to cisplatin and scleroderma, were studied using the records of 440665 patients on file up to 31 December 1993. There were 83 patients with Fabry's disease (0.0188%), 85 patients with CsA nephropathy (0.0193%), 120 patients with cisplatin nephropathy (0.0272%) and 625 patients with scleroderma (0.142%). Scleroderma was introduced as a primary renal disease (PRD) in the ERA-EDTA Registry in 1977. Seven patients were accepted for RRT in that year, whereas the number increased to over 50 new patients per year after 1986. More than half of the patients were aged over 55 years, and 68% of them were women. Survival rate of dialysis patients suffering from scleroderma was 22% at 5 years, compared to 51% in patients with standard primary renal diseases. The main causes of death were cardiovascular complications (41%), cachexia (15%) and infection (10%). Survival of first graft in a small number of 28 patients was 44% at 3 years, compared to 60% in standard PRD. Patient survival after first transplant, however, was higher by 32% at 3 years compared to that of dialysis patients. Cisplatin nephropathy was introduced as a PRD in the ERA-EDTA Registry in 1985, and since then six to 19 new patients have been accepted for RRT each year. The main reason for undergoing cisplatin treatment was ovarian (32%) and testicular cancer (21%), and the mean interval from treatment to RRT was 21.5 months, ranging widely from 0.1 to 131 months. Patient survival on dialysis was 22% at 5 years, compared to 51% in patients with standard PRD. Malignancy and cachexia accounted for over 60% of the total number of deaths. CsA nephropathy was introduced as a PRD in the ERA-EDTA Registry in 1985 and, despite its rarity, is of particular interest as a new iatrogenic entity resulting from CsA administration, mainly in solid organ transplantation. In 1985, two new patients commenced RRT in Europe, and the number increased to 59 in 1991-93. The main reason for undergoing CsA treatment was heart (68%) and liver transplant (22%), and the mean interval from treatment to RRT was 50.2 months, ranging from 5 to 90 months. Patient survival on dialysis was 46% at 4 years, compared to 58% in patients with standard primary nephropathies. Cardiovascular causes (48%) and infection (17%) were the main causes of death. Fabry's disease was introduced as a PRD in the ERA-EDTA Registry in 1985, and since the four to 13 new patients per year have commenced RRT in Europe. It is a sex-linked recessive disorder primarily affecting males (87%), and the mean age at start of RRT was 38 years. Proteinuria, skin lesions and painful paresthesiae were the most common presenting symptoms, and over 70% of the patients were hypertensive and had significant cardiovascular problems at RRT. Patient survival on dialysis was 41% at 5 years, compared to 68% in patients with standard primary nephropathies. Cardiovascular complications (48%) and cachexia (17%) were the main causes of death. Graft survival at 3 years in 33 patients was not inferior to that of patients with standard nephropathies (72% vs 69%), and patient survival after transplantation was comparable to that of patients under 55 years of age with standard PRD. (ABSTRACT TRUNCATED)

Current status of renal replacement therapy in Japan

The study of the current status of renal replacement therapy in Japan is based on the analysis of data from the registry reports for regular dialysis therapy and kidney transplantation. The total number of patients receiving regular dialysis therapy was 123,926 at the end of 1992: 117,809 (95.1%) on hemodialysis and 6,117 (4.9%) on peritoneal dialysis. The primary diseases of newly accepted patients were chronic glomerulonephritis (42.2%), diabetic nephropathy (28.4%), nephrosclerosis (5.9%), polycystic kidney disease (2.7%), chronic pyeronephritis (1.6%), and others. The number of kidney transplant patients in Japan was 8,384 at the end of 1991: 6,154 (73.4%) received a living donor transplantation and 2,230 (26.9%) received a cadaver donor transplantation. Overall 5-year survival rates of dialysis patients were 60.4%: 69.7% for chronic glomerulonephritis, 41.7% for diabetic nephropathy, 39.6% for nephrosclerosis, 73.6% for diffuse polycyustic kidney disease, and 66.6% for chronic pyeronephritis. The causes of death of dialysis patients were heart failure (31.1%), cerebrovascular accident (13.6%), infectious dieases (11.3%), malignancies (7.1%), cahexia/uremia (6.7%), myocardial infarction (5.8%), and others. The gross mortality rate of dialysis patients was increased in cases of less than 4 hours of the average length of each dialysis session, less than 4% and more than 9% of the average weight loss during each dialysis session, less than 1.0 of Kt/V, and less than 0.9 and more than 1.7 g/kg/d of protein catabolic rate. Overall 5-year patient and graft survival rates of kidney transplant patients since 1964 were 82.7% and 60.3%: 84.4% and 65.0% in living donor cases, and 77.4% and 46.2% in cadaver donor case, respectively. Those since 1983 were 90.1% and 68.2%: 91.3% and 72.6% in living donor cases, and 87.8% and 59.3%, respectively. Graft survival rates were superior in cases treated with combined steroid, cyclosporine and azathioprine or mizoribine, to those treated with other immunosuppressive regimens, and they decreased as the number of HLA-A, -B and -DR increased.

Effect of age and diagnosis on survival of older patients beginning chronic dialysis

<h3>Objective.</h3> —To assess the survival of elderly patients in the United States beginning chronic dialysis for end-stage renal disease caused by diabetes mellitus, hypertension, glomerulonephritis, polycystic kidney disease, and other causes. <h3>Design.</h3> —A secondary analysis of data obtained from the Health Care Financing Administration. <h3>Patients.</h3> —All Medicare end-stage renal disease patients 55 years of age or older (n=95 394) who began chronic dialysis treatment in the US between 1982 and 1987. <h3>Main Outcome Measures.</h3> —The 1-, 3-, and 5-year survival rates for each of six age strata and, within each strata, for each of the four most frequent causes of renal failure. <h3>Results.</h3> —Survival rates of dialysis patients fell precipitously, and much more rapidly for the study group than for the general population, as a function of advancing age. Older patients with diabetic nephropathy fared particularly badly, such that no patients with diabetic nephropathy aged 85 years or more survived 5 years. <h3>Conclusions.</h3> —Mortality rates of patients older than 55 years beginning chronic dialysis treatment increased dramatically as age at initiation of dialysis increased. Clinically meaningful survival data should prove useful to persons making decisions about the initiation of chronic dialysis. (<i>JAMA</i>. 1994;271:34-36)