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      Analysis of Patients Dying within One Year of Starting Renal Replacement Therapy

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          Abstract

          Background: The annual gross mortality of end-stage renal failure patients remains very high (approximately 15-20%) leading some to question the wisdom of accepting patients with limited prognosis for dialysis. We have reviewed the demographic and clinical characteristics of patients who died within a year of commencing renal replacement therapy (RRT) over a 5-year period to establish whether these patients could be identified at the start of therapy. Methods: Case notes of patients who died within 1 year of commencing RRT between 1st April, 1991 and 31st March, 1996 were reviewed. Comorbidity at the start of dialysis was used to classify patients into high-, medium- and low-risk groups using two published scales to determine whether either graded a high proportion of deaths as high risk. Factors such as age, social circumstances, cause of death, renal diagnosis and mode of dialysis were also analysed. Results: 17.5% of patients commencing RRT died in the first year. Not all of these patients could be identified as high risk by comorbidity assessment at dialysis initiation - 50% of patients who died were classified by one scale as medium risk. Age did not clearly predict outcome, as 42% of patients who died were less than 65 years old. Conclusion: These data suggest that it is difficult to use current risk stratifications to accurately predict outcome on RRT.

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          The urea reduction ratio and serum albumin concentration as predictors of mortality in patients undergoing hemodialysis.

          Among patients with end-stage renal disease who are treated with hemodialysis, solute clearance during dialysis and nutritional adequacy are determinants of mortality. We determined the effects of reductions in blood urea nitrogen concentrations during dialysis and changes in serum albumin concentrations, as an indicator of nutritional status, on mortality in a large group of patients treated with hemodialysis. We analyzed retrospectively the demographic characteristics, mortality rate, duration of hemodialysis, serum albumin concentration, and urea reduction ratio (defined as the percent reduction in blood urea nitrogen concentration during a single dialysis treatment) in 13,473 patients treated from October 1, 1990, through March 31, 1991. The risk of death was determined as a function of the urea reduction ratio and serum albumin concentration. As compared with patients with urea reduction ratios of 65 to 69 percent, patients with values below 60 percent had a higher risk of death during follow-up (odds ratio, 1.28 for urea reduction ratios of 55 to 59 percent and 1.39 for ratios below 55 percent). Fifty-five percent of the patients had urea reduction ratios below 60 percent. The duration of dialysis was not predictive of mortality. The serum albumin concentration was a more powerful (21 times greater) predictor of death than the urea reduction ratio, and 60 percent of the patients had serum albumin concentrations predictive of an increased risk of death (values below 4.0 g per deciliter). The odds ratio for death was 1.48 for serum albumin concentrations of 3.5 to 3.9 g per deciliter and 3.13 for concentrations of 3.0 to 3.4 g per deciliter. Diabetic patients had lower serum albumin concentrations and urea reduction ratios than nondiabetic patients. Low urea reduction ratios during dialysis are associated with increased odds ratios for death. These risks are worsened by inadequate nutrition.
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            Author and article information

            Journal
            AJN
            Am J Nephrol
            10.1159/issn.0250-8095
            American Journal of Nephrology
            S. Karger AG
            0250-8095
            1421-9670
            2000
            October 2000
            15 November 2000
            : 20
            : 5
            : 358-363
            Affiliations
            Department of Nephrology, Leicester General Hospital, Leicester, UK
            Article
            13616 Am J Nephrol 2000;20:358–363
            10.1159/000013616
            11092991
            © 2000 S. Karger AG, Basel

            Copyright: All rights reserved. No part of this publication may be translated into other languages, reproduced or utilized in any form or by any means, electronic or mechanical, including photocopying, recording, microcopying, or by any information storage and retrieval system, without permission in writing from the publisher. Drug Dosage: The authors and the publisher have exerted every effort to ensure that drug selection and dosage set forth in this text are in accord with current recommendations and practice at the time of publication. However, in view of ongoing research, changes in government regulations, and the constant flow of information relating to drug therapy and drug reactions, the reader is urged to check the package insert for each drug for any changes in indications and dosage and for added warnings and precautions. This is particularly important when the recommended agent is a new and/or infrequently employed drug. Disclaimer: The statements, opinions and data contained in this publication are solely those of the individual authors and contributors and not of the publishers and the editor(s). The appearance of advertisements or/and product references in the publication is not a warranty, endorsement, or approval of the products or services advertised or of their effectiveness, quality or safety. The publisher and the editor(s) disclaim responsibility for any injury to persons or property resulting from any ideas, methods, instructions or products referred to in the content or advertisements.

            Page count
            Figures: 2, Tables: 5, References: 22, Pages: 6
            Product
            Self URI (application/pdf): https://www.karger.com/Article/Pdf/13616
            Categories
            Clinical Study

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