Can we improve early mortality in patients receiving renal replacement therapy?

W Metcalfe, I H Khan, G J Prescott, K Simpson, A M MacLeod, Scottish Renal Registry

Research output: Contribution to journalArticle

76 Citations (Scopus)

Abstract

Background Approximately one in eight patients with endstage renal disease (ESRD) die within the first three months of starting renal replacement therapy (RRT). We investigated which factors might improve this early mortality.

Methods. We performed a prospective nationwide study of all patients commencing RRT for ESRD in Scotland over one year. Patients were classified according to how they presented to start RRT, their burden of comorbid diseases, access prepared for dialysis, and duration of care by a nephrologist prior to commencing RRT. Those factors most strongly associated with death within 90 days of commencing treatment were determined by logistic regression analysis.

Results. Patients with an acute unexpected element to their presentation for RRT had early mortality rates between 6.0 and 8.9 times greater than those who commenced RRT electively after a period of care from a nephrologist. Patients in high and medium comorbidity risk groups had early mortality rates of 4.7 and 2.2 times greater than those in the low-risk group. Low serum albumin had a significant association with early death. Patients who progressed steadily to ESRD, who had a planned start to dialysis, and who had mature access were 3.6 times more likely to survive beyond three months than those with no access; they were, however, also younger with less comorbidity.

Conclusions. The factors principally associated with early mortality are nonelective presentation for RRT, comorbid illness, and low serum albumin. Patients cared for by a nephrologist before requiring RRT who have mature access have better short-term survival than those without access. They are also younger with less comorbidity. It may be possible to improve short-term survival in this "unplanned" group if referred early to facilitate reducing cardiovascular risk factors and preparation for RRT.

Original languageEnglish
Pages (from-to)2539-2545
Number of pages7
JournalKidney International
Volume57
Publication statusPublished - 2000

Keywords

  • Scottish Renal Registry
  • end-stage renal disease
  • dialysis
  • cormorbidity
  • serum albumin
  • HEMODIALYSIS-PATIENTS
  • MAINTENANCE DIALYSIS
  • EARLY DEATH
  • FAILURE
  • NEPHROLOGIST
  • PREDICTION
  • MORBIDITY
  • SURVIVAL
  • DISEASE
  • RISK

Cite this

Metcalfe, W., Khan, I. H., Prescott, G. J., Simpson, K., MacLeod, A. M., & Scottish Renal Registry (2000). Can we improve early mortality in patients receiving renal replacement therapy? Kidney International, 57, 2539-2545.

Can we improve early mortality in patients receiving renal replacement therapy? / Metcalfe, W ; Khan, I H ; Prescott, G J ; Simpson, K ; MacLeod, A M ; Scottish Renal Registry.

In: Kidney International, Vol. 57, 2000, p. 2539-2545.

Research output: Contribution to journalArticle

Metcalfe, W, Khan, IH, Prescott, GJ, Simpson, K, MacLeod, AM & Scottish Renal Registry 2000, 'Can we improve early mortality in patients receiving renal replacement therapy?' Kidney International, vol. 57, pp. 2539-2545.
Metcalfe W, Khan IH, Prescott GJ, Simpson K, MacLeod AM, Scottish Renal Registry. Can we improve early mortality in patients receiving renal replacement therapy? Kidney International. 2000;57:2539-2545.
Metcalfe, W ; Khan, I H ; Prescott, G J ; Simpson, K ; MacLeod, A M ; Scottish Renal Registry. / Can we improve early mortality in patients receiving renal replacement therapy?. In: Kidney International. 2000 ; Vol. 57. pp. 2539-2545.
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abstract = "Background Approximately one in eight patients with endstage renal disease (ESRD) die within the first three months of starting renal replacement therapy (RRT). We investigated which factors might improve this early mortality.Methods. We performed a prospective nationwide study of all patients commencing RRT for ESRD in Scotland over one year. Patients were classified according to how they presented to start RRT, their burden of comorbid diseases, access prepared for dialysis, and duration of care by a nephrologist prior to commencing RRT. Those factors most strongly associated with death within 90 days of commencing treatment were determined by logistic regression analysis.Results. Patients with an acute unexpected element to their presentation for RRT had early mortality rates between 6.0 and 8.9 times greater than those who commenced RRT electively after a period of care from a nephrologist. Patients in high and medium comorbidity risk groups had early mortality rates of 4.7 and 2.2 times greater than those in the low-risk group. Low serum albumin had a significant association with early death. Patients who progressed steadily to ESRD, who had a planned start to dialysis, and who had mature access were 3.6 times more likely to survive beyond three months than those with no access; they were, however, also younger with less comorbidity.Conclusions. The factors principally associated with early mortality are nonelective presentation for RRT, comorbid illness, and low serum albumin. Patients cared for by a nephrologist before requiring RRT who have mature access have better short-term survival than those without access. They are also younger with less comorbidity. It may be possible to improve short-term survival in this {"}unplanned{"} group if referred early to facilitate reducing cardiovascular risk factors and preparation for RRT.",
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TY - JOUR

T1 - Can we improve early mortality in patients receiving renal replacement therapy?

AU - Metcalfe, W

AU - Khan, I H

AU - Prescott, G J

AU - Simpson, K

AU - MacLeod, A M

AU - Scottish Renal Registry

PY - 2000

Y1 - 2000

N2 - Background Approximately one in eight patients with endstage renal disease (ESRD) die within the first three months of starting renal replacement therapy (RRT). We investigated which factors might improve this early mortality.Methods. We performed a prospective nationwide study of all patients commencing RRT for ESRD in Scotland over one year. Patients were classified according to how they presented to start RRT, their burden of comorbid diseases, access prepared for dialysis, and duration of care by a nephrologist prior to commencing RRT. Those factors most strongly associated with death within 90 days of commencing treatment were determined by logistic regression analysis.Results. Patients with an acute unexpected element to their presentation for RRT had early mortality rates between 6.0 and 8.9 times greater than those who commenced RRT electively after a period of care from a nephrologist. Patients in high and medium comorbidity risk groups had early mortality rates of 4.7 and 2.2 times greater than those in the low-risk group. Low serum albumin had a significant association with early death. Patients who progressed steadily to ESRD, who had a planned start to dialysis, and who had mature access were 3.6 times more likely to survive beyond three months than those with no access; they were, however, also younger with less comorbidity.Conclusions. The factors principally associated with early mortality are nonelective presentation for RRT, comorbid illness, and low serum albumin. Patients cared for by a nephrologist before requiring RRT who have mature access have better short-term survival than those without access. They are also younger with less comorbidity. It may be possible to improve short-term survival in this "unplanned" group if referred early to facilitate reducing cardiovascular risk factors and preparation for RRT.

AB - Background Approximately one in eight patients with endstage renal disease (ESRD) die within the first three months of starting renal replacement therapy (RRT). We investigated which factors might improve this early mortality.Methods. We performed a prospective nationwide study of all patients commencing RRT for ESRD in Scotland over one year. Patients were classified according to how they presented to start RRT, their burden of comorbid diseases, access prepared for dialysis, and duration of care by a nephrologist prior to commencing RRT. Those factors most strongly associated with death within 90 days of commencing treatment were determined by logistic regression analysis.Results. Patients with an acute unexpected element to their presentation for RRT had early mortality rates between 6.0 and 8.9 times greater than those who commenced RRT electively after a period of care from a nephrologist. Patients in high and medium comorbidity risk groups had early mortality rates of 4.7 and 2.2 times greater than those in the low-risk group. Low serum albumin had a significant association with early death. Patients who progressed steadily to ESRD, who had a planned start to dialysis, and who had mature access were 3.6 times more likely to survive beyond three months than those with no access; they were, however, also younger with less comorbidity.Conclusions. The factors principally associated with early mortality are nonelective presentation for RRT, comorbid illness, and low serum albumin. Patients cared for by a nephrologist before requiring RRT who have mature access have better short-term survival than those without access. They are also younger with less comorbidity. It may be possible to improve short-term survival in this "unplanned" group if referred early to facilitate reducing cardiovascular risk factors and preparation for RRT.

KW - Scottish Renal Registry

KW - end-stage renal disease

KW - dialysis

KW - cormorbidity

KW - serum albumin

KW - HEMODIALYSIS-PATIENTS

KW - MAINTENANCE DIALYSIS

KW - EARLY DEATH

KW - FAILURE

KW - NEPHROLOGIST

KW - PREDICTION

KW - MORBIDITY

KW - SURVIVAL

KW - DISEASE

KW - RISK

M3 - Article

VL - 57

SP - 2539

EP - 2545

JO - Kidney International

JF - Kidney International

SN - 0085-2538

ER -