Predictors of Early Mortality among Incident US Hemodialysis Patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS)

Abstract

Mortality risk among hemodialysis (HD) patients may be highest soon after initiation of HD. A period of elevated mortality risk was identified among US incident HD patients, and which patient characteristics predict death during this period and throughout the first year was examined using data from the Dialysis Outcomes and Practice Patterns Study (DOPPS; 1996 through 2004). A retrospective cohort study design was used to identify mortality risk factors. All patient information was collected at enrollment. Life-table analyses and discrete logistic regression were used to identify a period of elevated mortality risk. Cox regression was used to estimate adjusted hazard ratios (HR) measuring associations between patient characteristics and mortality and to examine whether these associations changed during the first year of HD. (1), and a higher mortality rate within the first year after initiation of HD has been described (2). Identifying the period of highest risk for death after initiation of HD and factors that are associated with this higher risk are important to the care of patients who are new to HD (incident). Observational studies among prevalent HD patients have identified patient characteristics that are associated with greater mortality risk, including white race, older age, low serum albumin levels, low and elevated serum phosphorus levels, anemia, and cardiovascular disease (traditional risk factors) (3-14), as well as other nontraditional risk factors, including C-reactive protein and IL-6 levels (15,16). Studies also have supported the importance of early nephrology referral in the predialysis period for reducing mortality after HD initiation (17)(18)(19). Because these studies typically have included prevalent rather than incident patients, only limited information is available concerning mortality rates and factors that influence mortality immediately after HD initiation. One reason for this may be the 90-d Medicare entitlement period (coordination of benefits) during which coverage is not guaranteed (1). The few studies that have assessed mortality rates or risk predictors in the period immediately after HD initiation (2,20 -24) suggest an elevated mortality risk in the first 90 d, but it is unclear whether that elevation is limited to the first 90 d. One population-based study (2) found that 6% of HD patients died within the first 90 d, accounting for nearly 35% of deaths within the first year.Studies that quantify mortality rates and identify mortality predictors among incident HD populations are useful for understanding the influence of predialysis care and length of time on dialysis. Data from the 2004 Annual Dialysis Report (1) indicate higher mortality rates for patients who have received HD for Ͼ5 yr as compared with Ͻ2 yr, suggesting that length of time on HD modifies mortality risk. Most patients begin HD

Pengembangan Model Prediksi Mortalitas 3 Bulan Pertama pada Pasien Penyakit Ginjal Kronik yang Menjalani Hemodialisis

“…Hanya sedikit penelitian yang fokus pada kesintasan pada periode awal setelah inisiasi dialisis. [7][8][9][10][11][12] Bahkan, angka kematian tahun pertama yang dilaporkan oleh U.S. Renal Data System sebesar 19,6% pada tahun 1997 pada analisisnya mengeksklusi pasien yang meninggal dalam 90 hari pertama setelah HD. Padahal, penelitian lainnya menyebutkan bahwa angka kematian justru didapatkan tertinggi pada minggu-minggu pertama setelah HD.…”

“…Penyebab kematian lain yang didapatkan antara lain infeksi, vaskular, dan penyakit lainnya seperti penyakit hati dan saluran cerna. 8 Angka kematian dini yang tinggi pada pasien HD juga didapatkan di Indonesia. Data Unit HD Rumah Sakit Cipto Mangunkusumo Jakarta pada tahun 2000 menyebutkan bahwa dari keseluruhan pasien PGK yang menjalani HD kronik didapatkan 50% meninggal dalam 1 tahun pertama.…”

“…Pada kedua penelitian tersebut, hanya sebagian kecil pasien yang telah memiliki akses permanen. 8,10 Kesiapan akses vaskular berhubungan dengan waktu rujukan yang tepat dan perawatan sebelum HD. Rujukan dini ke nefrologis memberikan waktu untuk nefrologis melakukan perawatan pradialisis dengan baik, termasuk mempersiapkan akses vaskular.…”

“…Untuk memudahkan penerapan klinis skor dibagi menjadi 3 kelompok berdasarkan persentase probabilitas kematian, yaitu risiko ringan (skor 0-3), sedang (skor 4-6) dan tinggi (7)(8)(9). Probabilitas mortalitas masing-masing kelompok dapat dilihat pada tabel 5.8.…”

Acute Haemodialysis-induced Changes in Tissue Doppler Echocardiography Parameters

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Cardiovascular diseases are common in patients with endstage renal disease (ESRD) and are the main causes of morbidity and mortality (1)(2)(3). A large body of evidence has accrued indicating that a portion of this cardiovascular damage may be due to haemodialysis (HD) (4,5).

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