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.
Bibliographical noteThis work was funded by a grant from the Scottish Office Department of Health Clinical Resource and Audit Group (CRAG). The views expressed are those of the authors and are not necessarily those of either the Scottish Office Department of Health or CRAG. The Scottish Renal Registry was funded jointly by all the Scottish Health Boards. We would like to thank the staff of Scotland's adult renal units for their help in executing this study and for commenting on the manuscript: Aberdeen Royal Infirmary; Crosshouse Hospital, Kilmarnock; Dumfries and Galloway Royal Infirmary; Glasgow Royal Infirmary; Monklands Hospital, Airdrie; Ninewells Hospital, Dundee; Queen Margaret's Hospital, Dunfermline; Raigmore Hospital, Inverness; Royal Infirmary of Edinburgh; Stobhill Hospital, Glasgow; Western Infirmary, Glasgow.
- Scottish Renal Registry
- end-stage renal disease
- serum albumin
- MAINTENANCE DIALYSIS
- EARLY DEATH