EARLY DEATH IN DIALYSIS PATIENTS - RISK-FACTORS AND IMPACT ON INCIDENCE AND MORTALITY-RATES

Patients who die within the first 90 days after beginning dialysis are not included in mortality rates and may be absent from incidence coun ts. To identify factors associated with mortality within 3 months of t he initiation of dialysis for ESRD and to estimate the impact of early deaths on ESRD incidence and mortality rates, this study investigated 15,245 patients who began dialysis in Georgia, North Carolina, and So uth Carolina over a 5-yr period. Data were collected by dialysis facil ity staff and reported to an ESRD registry, Six percent of all new pat ients died within 90 days of dialysis initiation (32% of all deaths oc curring in the first year of treatment). Characteristics independently associated with increased risk of early death included older age, whi te race, male gender, physical and nutritional impairment, smoking, an d the presence of cancer, congestive heart failure, clinical depressio n, and history of myocardial infarction, Depending on race-gender grou p, age-adjusted mortality rates based on this cohort were underestimat ed by 3 to 12% when patients who died early were excluded. These resul ts suggest that certain patient characteristics-some potentially modif iable-confer increased risk of early death, and that the systematic ex clusion of patients who die early from the U.S. national registry subs tantially influences ESRD mortality rates.