Trend and determinants of mortality in incident hemodialysis patients of the Lazio region

Maurizio Bossola; Anteo Di Napoli; Laura Angelici; Anna Maria Bargagli; Silvia Cascini; Ursula Kirchmayer; Nera Agabiti; Marina Davoli; Claudia Marino

doi:10.1186/s12882-023-03170-w

Trend and determinants of mortality in incident hemodialysis patients of the Lazio region

BMC Nephrol. 2023 Apr 26;24(1):111. doi: 10.1186/s12882-023-03170-w.

Authors

Maurizio Bossola^{1

2}, Anteo Di Napoli³, Laura Angelici⁴, Anna Maria Bargagli⁵, Silvia Cascini⁵, Ursula Kirchmayer⁵, Nera Agabiti⁵, Marina Davoli⁵, Claudia Marino⁵

Affiliations

¹ Servizio Emodialisi, Università Cattolica del Sacro Cuore facoltà di Medicina e Chirurgia, Rome, Italy.
² Servizio Emodialisi, Fondazione Policlinico Universitario Agostino Gemelli IRCCS, Rome, Italy.
³ National Institute for Health, Migration and Poverty, 00153, Rome, Italy.
⁴ Department of Epidemiology, Regional Health Service - Lazio, Via Cristoforo Colombo, 112, 00147, Rome, Italy. l.angelici@deplazio.it.
⁵ Department of Epidemiology, Regional Health Service - Lazio, Via Cristoforo Colombo, 112, 00147, Rome, Italy.

Abstract

Background: . In the last decades some studies observed a moderate progressive decrease in short-term mortality in incident hemodialysis patients. The aim of the study is to analyse the mortality trends in patients starting hemodialysis using the Lazio Regional Dialysis and Transplant Registry.

Methods: . Patients who started chronic hemodialysis between 2008 and 2016 were included. Annual 1-year and 3-year Crude Mortality Rate*100 Person Years (CMR*100PY) overall, by gender and age classes were calculated. Cumulative survival estimates at 1 year and 3 years since the date of starting hemodialysis were presented as Kaplan-Meier curves for the three periods and compared using the log-rank test. The association between periods of incidence in hemodialysis and 1-year and 3-year mortality were investigated by means of unadjusted and adjusted Cox regression models. Potential determinants of both mortality outcomes were also investigated.

Results: . Among 6,997 hemodialysis patients (64.5% males, 66.1% over 65 years old) 923 died within 1 year and 2,253 within 3 years form incidence; CMR*100PY were 14.1 (95%CI: 13.2-15.0) and 13.7 (95%CI: 13.2-14.3), respectively; both remained unchanged over the years. Even after stratification by gender and age classes no significant changes emerged. Kaplan-Meier mortality curves did not show any statistically significant differences in survival at 1 year and 3 years from hemodialysis incidence across periods. No statistically significant associations were found between periods and 1-year and 3-year mortality. Factors associated with a greater increase in mortality are: being over 65 years, born in Italy, not being self-sufficient, having systemic versus undetermined nephropathy, having heart disease, peripheral vascular disease, cancer, liver disease, dementia and psychiatric illness, and receiving dialysis by catheter rather than fistula.

Conclusions: . The study shows that the mortality rate in patients with end-stage renal disease starting hemodialysis in the Lazio region was stable over 9 years.

Keywords: End-stage renal disease; Incident hemodialysis patients; Mortality trend..

Publication types

Research Support, Non-U.S. Gov't

MeSH terms

Aged
Female
Humans
Incidence
Kidney Failure, Chronic* / therapy
Male
Patients
Proportional Hazards Models
Renal Dialysis*
Retrospective Studies