Death during the first 90 days of dialysis: a case control study

Area of Science:

• Nephrology
• Clinical Medicine
• Public Health

Background:

• Survival data comparisons are vital for assessing renal replacement therapy (RRT) center performance.
• Early deaths within 90 days of RRT initiation can significantly skew performance metrics.
• Existing registry data often exclude these early deaths, limiting understanding of influencing factors.

Purpose of the Study:

• To investigate factors associated with patient mortality within the first 90 days of commencing RRT.
• To compare characteristics of patients who died early on RRT versus those who survived longer.

Main Methods:

• A case-control study comparing 42 patients who died within 90 days of RRT (group A) with 42 matched controls who survived longer (group B).
• Data collected from a single Scottish renal unit between 1971 and 1992.
• Analysis included patient demographics, medical history, RRT modality, and pre-RRT follow-up duration.

Main Results:

• The proportion of early RRT deaths increased from 2% to 12% over the study period.
• Group A patients were more likely to have received emergency dialysis (33 vs 9), have arteriosclerotic renal artery stenosis (14 vs 1), and a history of smoking (15 vs 2).
• Group A had significantly shorter pre-RRT follow-up (1.1 vs 10.6 months) and more coexisting diseases (1 vs 17).

Conclusions:

• Early mortality in RRT is associated with specific clinical factors including emergency dialysis, vascular disease, and smoking history.
• Shorter pre-RRT evaluation periods correlate with higher early death rates.
• These findings highlight the need to account for early RRT deaths in performance evaluations and patient management.