One-year mortality after dialysis initiation nearly double prior estimates
Background: The United States Renal Data System registry estimates that approximately 30% of patients die within 1 year of initiating hemodialysis.
Dr. Bryan Lublin
Study design: Retrospective, observational analysis.
Setting: The Health and Retirement Study is a nationally representative survey of Medicare beneficiaries during 1998-2014. Medicare claims were linked to mortality data from the National Death Index.
Synopsis: Among 391 patients who initiated dialysis, 22.5%, 44.2%, and 54.5% died within 30 days, 6 months, and 1 year, respectively. After multivariate adjustment, 1-year mortality was higher among those who initiated dialysis while inpatients (hazard ratio, 2.17; 62.2%), had any activity of daily living dependence prior to dialysis (HR, 1.88; 73.0%), or had more than four comorbidities (HR, 1.5; 59.9%).
Bottom line: Medicare beneficiaries may have significantly higher mortality after initiating dialysis than prior data suggest.
Citation: Wachterman MW et al. One-year mortality after dialysis initiation among older adults. JAMA Intern Med. 2019 Apr 22. doi: 10.1001/jamainternmed.2019.0125.
Dr. Lublin is a hospitalist at the University of Colorado at Denver, Aurora.
