Morbidity and mortality on chronic haemodialysis: A 10-year Swiss single centre analysis

Breidthardt, Tobias; Moser-Bucher, Cora; Praehauser, Claudia; Garzoni, Daniela; Bächler, Katrin; Steiger, Juerg; Dickenmann, Michael; Mayr, Michael

doi:10.4414/smw.2011.13150

Cited by 14 publications

(17 citation statements)

References 25 publications

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“…The data of the DOPPS study from 2004 show an age range from 58.0 years in the UK to 62.4 years in Italy [10]. Also, our data correspond well with reports from Switzerland by Saudan et al from the French part of the country [6], and by Breidthart et al from Basel [11]. In Saudan's publication, mean age of 64 ± 15 years in prevalent patients of 2001 matched exactly that in our own cohort for the same year (Figure 1).…”

Section: Discussionsupporting

confidence: 90%

“…These findings are in agreement with the two recently published studies from Switzerland mentioned above with comparable socio-economic background, analyzing patient data from around the year 2000. They documented 3- and 5-year survival of 68 and 46%, respectively, in Basel [11], and 61% 3-year survival in the French part of Switzerland [6]. Survival after initiation of dialysis decreased significantly in our cohort by about 50 and 35 percent in survival time censored for study follow-up and time to death, respectively, since 1970.…”

Section: Discussionmentioning

confidence: 67%

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Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

et al. 2012

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BackgroundLong term longitudinal data are scarce on epidemiological characteristics and patient outcomes in patients on maintenance dialysis, especially in Switzerland. We examined changes in epidemiology of patients undergoing renal replacement therapy by either hemodialysis or peritoneal dialysis over four decades.MethodsSingle center retrospective study including all patients which initiated dialysis treatment for ESRD between 1970 and 2008. Analyses were performed for subgroups according to dialysis vintage, based on stratification into quartiles of date of first treatment. A multivariate model predicting death and survival time, using time-dependent Cox regression, was developed.Results964 patients were investigated. Incident mean age progressively increased from 48 ± 14 to 64 ± 15 years from 1st to 4th quartile (p < 0.001), with a concomitant decrease in 3- and 5-year survival from 72.2 to 67.7%, and 64.1 to 54.8%, respectively. Nevertheless, live span continuously increased from 57 ± 13 to 74 ± 11 years (p < 0.001). Patients transplanted at least once were significantly younger at dialysis initiation, with significantly better survival, however, shortened live span vs. individuals remaining on dialysis. Among age at time of initiating dialysis therapy, sex, dialysis modality and transplant status, only transplant status is a significant independent covariate predicting death (HR: 0.10 for transplanted vs. non-transplanted patients, p = 0.001). Dialysis vintage was associated with better survival during the second vs. the first quartile (p = 0.026).DiscussionWe document an increase of a predominantly elderly incident and prevalent dialysis population, with progressively shortened survival after initiation of renal replacement over four decades, and, nevertheless, a prolonged lifespan. Analysis of the data is limited by lack of information on comorbidity in the study population.ConclusionsSurvival in patients on renal replacement therapy seems to be affected not only by medical and technical advances in dialysis therapy, but may mostly reflect progressively lower mortality of individuals with cardiovascular and metabolic complications, as well as a policy of accepting older and polymorbid patients for dialysis in more recent times. This is relevant to make demographic predictions in face of the ESRD epidemic nephrologists and policy makers are facing in industrialized countries.

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Section: Discussionsupporting

confidence: 90%

Section: Discussionmentioning

confidence: 67%

Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

et al. 2012

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“…A series of recent studies was able to show that standard thrice-weekly HD is able to induce transient episodes of myocardial ischemia (4-7). In a study using H 2 15 O positron emission tomography to measure myocardial blood flow during dialysis, we demonstrated that HD precipitates reductions in myocardial blood flow, at peak dialytic stress, to the levels consistent with the development of overt myocardial ischemia. Of note, this study was conducted after all patients had undergone coronary angiography to exclude the presence of coronary artery disease (4).…”

Section: Discussionmentioning

confidence: 99%

“…Patients with ESRD undergoing long-term hemodialysis (HD) are at a substantially increased risk for death, with 1-, 3-, and 5-year mortality rates around 15%, 35%, and 55%, respectively (1,2). The latest U.S. Renal Data System Annual Report also showed an annual mortality rate of 221 deaths per 1000 patient-years in the United States (3).…”

Section: Introductionmentioning

confidence: 99%

Troponin T for the Detection of Dialysis-Induced Myocardial Stunning in Hemodialysis Patients

Breidthardt

Burton

Odudu

et al. 2012

Clinical Journal of the American Society of Nephrology

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Summary Background and objectives Circulating troponin T levels are frequently elevated in patients undergoing long-term dialysis. The pathophysiology underlying these elevations is controversial. Design, setting, participants, & measurements In 70 prevalent hemodialysis (HD) patients, HD-induced myocardial stunning was assessed echocardiographically at baseline and after 12 months. Nineteen patients were not available for the follow-up analysis. The extent to which predialysis troponin T was associated with the occurrence of HD-induced myocardial stunning was assessed as the primary endpoint. Results The median troponin T level in this hemodialysis cohort was 0.06 ng/ml (interquartile range, 0.02–0.10). At baseline, 64% of patients experienced myocardial stunning. These patients showed significantly higher troponin T levels than patients without stunning (0.08 ng/ml [0.05–0.12] versus 0.02 ng/ml [0.01–0.05]). Troponin T levels were significantly correlated to measures of myocardial stunning severity (number of affected segments: r=0.42; change in ejection fraction from beginning of dialysis to end of dialysis: r=−0.45). In receiver-operating characteristic analyses, predialytic troponin T achieved an area under the curve of 0.82 for the detection of myocardial stunning. In multivariable analysis, only ultrafiltration volume (odds ratio, 4.38 for every additional liter) and troponin T (odds ratio, 9.33 for every additional 0.1 ng/ml) were independently associated with myocardial stunning. After 12 months, nine patients had newly developed myocardial stunning and showed a significant increase in troponin T over baseline (0.03 ng/ml at baseline versus 0.05 ng/ml at year 1). Conclusions Troponin T levels in HD patients are associated with the presence and severity of HD-induced myocardial stunning.

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“…Patients with end‐stage renal disease (ESRD) undergoing chronic haemodialysis are at a substantially increased risk of death. Recent analyses found 1‐, 3‐, and 5‐year mortality rates in chronic haemodialysis patients in Switzerland to be around 15, 35, and 55%, respectively 1,2. The latest US Renal Data System (USRDS) annual report also showed an annual mortality rate of 221 deaths per 1000 patient years in the USA 3.…”

Section: Introductionmentioning

confidence: 99%

Increasing B‐type natriuretic peptide levels predict mortality in unselected haemodialysis patients

Breidthardt

Kalbermatter

Socrates

et al. 2011

European J of Heart Fail

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AimsCardiac disease is the major cause of death in patients undergoing chronic haemodialysis. Recent studies have found that B-type natriuretic peptide (BNP) levels accurately reflect the cardiovascular burden of dialysis patients. However, the prognostic potential of BNP measurements in dialysis patients remains unknown. Methods and resultsThe study included 113 chronic dialysis patients who were prospectively followed up. Levels of BNP were measured at baseline and every 6 months thereafter. The potential of baseline BNP and annual BNP changes to predict all-cause and cardiac mortality were assessed as endpoints. Median follow-up was 735 (354-1459) days; 35 (31%) patients died, 17 (15%) of them from cardiac causes. Baseline BNP levels were similar among survivors and non-survivors, and failed to predict all-cause and cardiac death. Cardiac death was preceded by a marked increase in BNP levels. In survivors BNP levels remained stable [median change: +175% (+20-+384%) vs. 214% (235-+35%) over the 18 months preceding either death or the end of follow-up, P , 0.001]. Hence, annual BNP changes adequately predicted all-cause and cardiac death in the subsequent year {AUC all-cause ¼ 0.70 [SD 0.05, 95% CI (0.60-0.81)]; AUC cardiac ¼ 0.82 [SD 0.04, 95%CI (0.73-0.90)]}. A BNP increase of 40% provided the best cut-off level. Cox regression analysis confirmed that annual increases over 40% were associated with a seven-fold increased risk for all-cause and cardiac death. ConclusionsAnnual BNP increases above 40% predicted all-cause and cardiac death in the subsequent year. Hence, serially measuring BNP levels may present a novel tool for risk stratification and treatment guidance of end-stage renal disease patients on chronic dialysis.--

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Morbidity and mortality on chronic haemodialysis: A 10-year Swiss single centre analysis

Abstract: Survival on chronic haemodialysis treatment in Switzerland compares favourably to international reference values. Dialysis withdrawal and the frequency of kidney transplantation impact long term patient outcome and should be adjusted for when comparing mortality analysis.

Cited by 14 publications

References 25 publications

Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

Epidemiologic trends in chronic renal replacement therapy over forty years: A Swiss dialysis experience

Troponin T for the Detection of Dialysis-Induced Myocardial Stunning in Hemodialysis Patients

Increasing B‐type natriuretic peptide levels predict mortality in unselected haemodialysis patients

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