DIALYSIS SURVIVAL IN A LARGE INNER-CITY FACILITY - A COMPARISON TO NATIONAL RATES

Impoverished patients may represent a high-risk population with poor s urvival. With 1993 U.S. Penal Data System survival tables (to adjust t he risk of death for differences in age, race, and ESRD diagnosis), th e mortality rates of patients over 3 yr in a large inner-city dialysis facility using high-flux technique were compared with national averag es. At least 93.7 of patients were African-American, 50% had incomes b elow $7,000 per year, and employment was 5% or less. Observed and expe cted deaths (the latter derived from the U.S. Penal Data System tables ) were used to calculate a standardized mortality ratio (observed deat hs/expected deaths); the U.S. average is 1.0. The standardized mortali ty ratio at this facility for each year was <0.600 and was significant ly lower than the U.S. average in 1991, in 1992 (P < 0.05), and for al l 3 yr (P < .001). Over all 3 yr, it was lower for females (0.540, P < 0.05), males (0.620, P < 0.05), patients with diabetes (0.593, P < 0. 05), and glomerulonephritis (0.318, P < 0.05). For the 3 yr, a Cox reg ression analysis revealed independent associations between mortality a nd age (P = 0.004), serum albumin (P = 0.02), Kt/V (P = 0.02), and dia lysis for more than 2 yr (P = 0.01). Patients with economic hardship c an attain survival significantly better than the national average with the provision of adequate dialysis, nutrition, and support services.