Abstract. Mortality rates among hemodialysis patients vary greatly across regions. Representative databases containing extensive profiles of patient characteristics and outcomes are lacking. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States (US) that captures extensive data relating to patient characteristics, prescriptions, laboratory values, practice patterns, and outcomes. This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr. The crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. After adjusting for age, gender, race, and 25 comorbid conditions, the relative risk (RR) of mortality was 2.84 (P Ͻ 0.0001) for Europe compared with Japan (reference group) and was 3.78 (P Ͻ 0.0001) for the US compared with Japan. The adjusted RR of mortality for the US versus Europe was 1.33 (P Ͻ 0.0001). For most comorbid diseases, prevalence was highest in the US, where the mean age (60.5 Ϯ 15.5 yr) was also highest. Older age and comorbidities were associated with increased risk of death (except for hypertension, which carried a multivariate RR of mortality of 0.74 [P Ͻ 0.0001]). Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US. Adjustments for the observed variability will allow study of association between practice patterns and outcomes.Outcomes among dialysis patients differ considerably between and within countries. One of the most concerning differences is the varying mortality rate across countries with large populations of dialysis patients. Held et al. (1) reported the mortality risk for the renal replacement population in the United States (US), adjusted for age and diabetes mellitus, to be 15% higher than the European risk and 33% higher than the Japanese risk.

Nonadherence was associated with increased mortality risk (skipping treatment, excessive IDWG, and high phosphate) and with hospitalization risk (skipping, high phosphate). Certain patient/facility characteristics also were associated with nonadherence.

There are differences in HCV prevalence and rate of seroconversion at the country and the hemodialysis facility level. The observed variation suggests opportunities for improved HCV outcomes.

Background There is limited information about the clinical and prognostic significance of patient-reported recovery time. Study Design Prospective cohort study. Setting & Participants 6,040 patients in the DOPPS. Predictor Answer to question, “How long does it take you to recover from a dialysis session?” categorized as follows: <2, 2–6, 7–12, or >12 hours. Outcomes & Measurements Cross-sectional and longitudinal associations between recovery time and patient characteristics, hemodialysis treatment variables, health-related quality of life (HRQoL) and hospitalization and mortality. Results 32% reported recovery time <2 hours; 41%, 2–6 hours; 17%, 7–12 hours; and 10%, >12 hours. Using proportional odds (ordinal) logistic regression, shorter recovery time was associated with male sex, full-time employment, and higher serum albumin. Longer recovery time was associated with older age, dialysis vintage, body mass index, diabetes, and psychiatric disorder. Greater intradialytic weight loss, longer dialysis session length, and lower dialysate sodium concentration were associated with longer recovery time. In facilities that used uniform dialysate sodium concentration for ≥90% of patients, the adjusted OR of longer recovery time, comparing dialysate sodium concentration <140 vs 140 mEq/L, was 1.72 (95% CI, 1.37–2.16). Recovery time was positively correlated with symptoms of kidney failure and kidney disease burden score, and inversely correlated with HRQoL mental and physical component summary scores. Using Cox regression, adjusting for potential confounders not influenced by recovery time, it was positively associated with first hospitalization and mortality (adjusted HRs for recovery time >12 vs. 2–6 hours of 1.22 [95% CI, 1.09–1.37] and 1.47 [95% CI, 1.19–1.83], respectively). Limitations Answers are subjective and not supported by physiological measurements. Conclusions Recovery time can be used to identify patients with poorer HRQoL and higher risks of hospitalization and mortality. Interventions to reduce recovery time and possibly to improve clinical outcomes, such as increasing dialysate sodium concentration, need to be tested in randomized trials.

Poor SQ is common among HD patients in DOPPS countries and is independently associated with several QOL indices, medication use patterns and mortality. Assessment and management of SQ should be an important component of care.