Mortality in the Veneto population on renal replacement therapy

Area of Science:

• Nephrology
• Clinical Epidemiology
• Public Health

Background:

• Renal replacement therapy (RRT) is crucial for end-stage renal disease patients.
• Understanding survival rates and treatment modality impacts is vital for patient care.
• The Veneto Dialysis and Transplantation Registry (VDTR) provides comprehensive regional data.

Purpose of the Study:

• To analyze survival rates and mortality risks for patients undergoing RRT.
• To compare outcomes across different RRT modalities: hemodialysis (HD), peritoneal dialysis (PD), and renal transplantation.
• To identify factors influencing excess mortality in the RRT population.

Main Methods:

• Time-to-event analysis and life table methods were used for survival calculations.
• Ederer II method estimated relative survival and excess mortality rates.
• A multistate model tracked patient transitions between treatments and death.

Main Results:

• Overall mortality rate was 12.5 per 100 patient-years; 5-year and 10-year relative survival rates were 59% and 41%, respectively.
• Hemodialysis (HD) patients exhibited significantly higher cumulative mortality (18% at 1 year, 70% at 10 years) compared to peritoneal dialysis (PD) patients (8% at 1 year, 54% at 10 years).
• Transplantation rates increased over time, particularly for PD patients (34% by year 5), positively impacting survival, while HD patients had lower transplant rates (16% by year 5).

Conclusions:

• While overall RRT mortality in Veneto is comparable to other regions, outcomes are heterogeneous and influenced by treatment modality.
• Hemodialysis (HD) is associated with higher mortality, especially in the first year post-initiation.
• Increased transplantation rates contribute to improved survival, highlighting the importance of timely transplantation for RRT patients.