Mortality in patients receiving renal replacement therapy, a single center study
Schrander-v d Meer, A.M.; van Saase, J.L.; Roodvoets, A.P.; van Dorp, W.T.
Clinical Nephrology 43(3): 174-179
1995
ISSN/ISBN: 0301-0430 PMID: 7774074 Document Number: 447389
We studied all patients receiving renal replacement therapy (RRT) in the Kennemer Gasthuis Dialysis Centre (Haarlem) during the period January 1st 1986 to January 1st 1991 in order to evaluate their mortality. Of the total number 205 patients, 76 had died in this period, 82 were still receiving RRT on December 31st 1991 and 47 had been transplanted. The most frequent cause of death was cardiovascular. Of the 76 patients who had died, 38 had requested cessation of dialysis. Of these, 26% had also a malignancy and 29% had irreversible brain damage (CVA, dementia). Compared to the expected mortality rate in the general population of The Netherlands, dialysis patients have a Standardized Mortality Rate (SMR) of 6.91 (95% Confidence Interval (CI) 4.72-9.54). Male patients had a SMR twice as high as females. Patients under age 50 had a SMR of 50.00 (95% CI 8.93-124.40) versus 50 and older 7.19 (95% CI 4.26-8.91). The SMR was similar for patients with and without cardiovascular comorbidity before entering RRT. A Kaplan-Meier plot showed a significant difference for not transplantable versus transplanted or transplantable patients, however SMR for these 3 groups revealed no difference. A Kaplan-Meier plot of patient survival of patients starting RRT after January 1986 n = 114) showed a linear decrease of 20% yearly mortality. No gender difference was found. We conclude that 1. RRT is associated with high mortality, 2. SMR of young patients is higher than of the elderly and SMR of men is twice as high as SMR of women. Interestingly Kaplan-Meier survival plot did not reveal this difference. 3. The occurrence of cardiovascular disease before RRT does not predict mortality and 4. SMRs of transplanted, transplantable and not transplantable patients are equal. Lastly, when evaluating survival SMR is obligatory.