MORTALITY IN PATIENTS RECEIVING RENAL REPLACEMENT THERAPY, A SINGLE-CENTER STUDY

We studied all patients receiving renal replacement therapy (RRT) in t he Kennemer Gasthuis Dialysis Centre (Haarlem) during the period Janua ry 1st 1986 to January 1st 1991 in order to evaluate their mortality. Of the total number 205 patients, 76 had died in this period, 82 were still receiving RRT on December 31st 1991 and 47 had been transplanted . The most frequent cause of death was cardiovascular. Of the 76 patie nts who had died, 38 had requested cessation of dialysis. Of these, 26 % had also a malignancy and 29% had irreversible brain damage (CVA, de mentia). Compared to the expected mortality rate in the general popula tion of The Netherlands, dialysis patients have a Standardized Mortali ty Rate (SMR) of 6.91 (95% Confidence Interval (CI) 4.72-9.54). Male p atients had a SMR twice as high as females. Patients under age 50 had a SMR of 50.00 (95% CI 8.93-124.30) versus 50 and older 7.19 (95% CI 4 .26-8.91). The SMR was similar for patients with and without cardiovas cular comorbidity before entering RRT. A Kaplan-Meier plot showed a si gnificant difference for not transplantable versus transplanted or tra nsplantable patients, however SMR for these 3 groups revealed no diffe rence. A Kaplan-Meier plot of patient survival of patients starting RR T after January 1986 (n = 114) showed a linear decrease of 20% yearly mortality. No gender difference was found. We conclude that 1. RRT is associated with high mortality, 2. SMR of young patients is higher tha n of the elderly and SMR of men is twice as high as SMR of women. Inte restingly Kaplan-Meier survival plot did not reveal this difference. 3 . The occurrence of cardiovascular disease before RRT does not predict mortality and 4. SMRs of transplanted, transplantable and not-transpl antable patients are equal. Lastly, when evaluating survival SMR is ob ligatory.