Mortality Trends in Patients Undergoing Hemodialysis, 2003-2021: Data from National Health Insurance Service in Korea

Background: Assessing recent changes in mortality among patients undergoing hemodialysis (HD) can help both to identify the causes of death most closely associated with these changes and to develop prevention strategies. This study explored trends in all-cause and cause-specific mortality among patients undergoing HD in South Korea using an analysis of national data. Methods: We used national death certificate and claims data from 2003 to 2021 provided by the National Health Insurance Service. Age-standardized mortality rates (ASRs) were calculated by standardizing to the 2011 population of patients undergoing HD. Joinpoint regression analysis was performed to calculate the annual percentage change (APC) in mortality. All-cause and cause-specific ASRs and APCs were evaluated for the study period. Results: The proportion of male and older adult patients increased over time. In particular, the proportion of patients aged ≥ 80 years in the 2018-2021 period was more than 4 times higher than in the 2003-2007 period. From 2003 to 2021, there were a total of 136,302 deaths among patients undergoing HD in South Korea. Cardiovascular causes accounted for 13.6% of deaths, and the majority (86.4%) were attributed to noncardiovascular causes. In 2003, the all-cause ASR was 174.1 per 1000 person-years, which steadily decreased to 114.5 per 1000 person-years in 2021. The ASR from cardiovascular disease remained unchanged from 2003 to 2013 but increased by 3.9% (95% confidence interval: 1.3 to 14.0) per year from 2013 to 2021. In contrast, the ASR from noncardiovascular disease decreased during the study period. Conclusions: Nationally representative data showed a declining trend in the ASR among patients undergoing HD from 2003 to 2021. Noncardiovascular disease mortality decreased during the study period, while cardiovascular disease mortality increased.