Excess Risk of Death Increases with Time from First Dialysis for Patients on the Waiting List: Implications for Renal Allograft Allocation Policy

Abstract

Background: Subgroups of patients registered on a kidney transplant waiting list have higher than usual mortality levels. This study used data from the French Renal Epidemiology and Information Network (REIN) Registry to quantify the impact over time of various comorbidities on the excess risk of death among patients on the waiting list. Methods: Lexis diagrams were used to analyze time since onset of end-stage renal disease and time since registration on the waiting list. The number of excess deaths was calculated by comparison with the number of expected deaths in the general population of the same age and sex. Results: During 45,013 person-years of follow-up, 7,224 patients died, 5,956 (82%) more than expected relative to the general population. There were 101 deaths among wait-listed dialysis patients, 76 more than expected. The excess risk of death increased by 45% per additional year on the waiting list (18-79%, p = 0.0005). Time from end-stage renal disease onset until list registration (p = 0.004), time since registration (p < 0.001), age >65 years (p = 0.008), the presence of a primary renal disease (p = 0.028), and the number of comorbidities (p = 0.035) were independent predictors of death while on the waiting list. Conclusions: The excess risk of death while on the waiting list increased faster in patients with comorbidities. These results require consideration of ways to accelerate access to transplantation in high-risk patients.

Clinical, immunological and ethical aspects of selecting a recipient for cadaver kidney transplantation

“…Например, очевидно, что по мере увеличения возраста и ухудшения коморбидного фона постепенно (и можно даже предположить, что линейно) возрастает риск смерти пациента. При этом по мере увеличения срока ожидания коморбидный фон будет ухудшаться (а значит, риск смертивозрастать) с большим темпом у пожилых пациентов по сравнению с молодыми [36]. Таким образом, даже эти три фактора (возраст, коморбидный фон и срок ожидания) порождают необходимость включения в регрессионную модель их взаимодействия с соответствующими коэффициентами.…”

Doctor can I buy a new kidney? I've heard it isn't forbidden: what is the role of the nephrologist when dealing with a patient who wants to buy a kidney?

“…Once again, the distribution may be interpreted in different ways, for example distribution of financial resources, of health care access, as well as of the treatments themselves, as in the case of kidney transplantation which is financially advantageous as compared to dialysis, but kidneys from deceased donors are not available for every patient, or at least are not available within a short period of time [ 87 – 91 ].…”

Arteriovenous Access Graft Infection: Standards of Reporting and Implications for Comparative Data Analysis

“…Hemodialysis (HD) is a complex attritional disease state that leads to a 45% annual increase in excess mortality. 1 Perhaps uniquely, the outcome and morbidity of HD is inherently related and may be altered through the method of providing HD, whether it is through a central venous catheter (CVC), arteriovenous fistula (AVF), or arteriovenous graft (AVG). 2,3 Renal transplantation is the ultimate form of renal replacement therapy (RRT) with dramatic benefits in morbidity, survival, and cost of treatment.…”