EFFECT OF RENAL DISEASES AND COMORBID CONDITIONS ON SURVIVAL IN CHRONIC DIALYSIS PATIENTS

International and geographical differences in the survival rates of ch ronic dialysis patients can be explained by differences in primary ren al disease, in the acceptance rate of elderly patients, and in predial ysis comorbid conditions. Several studies have shown the effects of th ese factors on survival. However, in most studies, a large number of p atients may leave for renal transplantation or transfer to other cente rs, so that precise analysis becomes impossible. Although the number o f patients in our registry is not so large (n = 1,982), we have few su ch problems and were able to examine the effects of the above-mentione d factors on patient survival using the Cox proportional hazard model. Hazard ratios (HR) and 95% confidence intervals were 0.739 and 0.366- 1.491 in patients with polycystic kidney disease (n = 38), 2.669 and 1 .513-4.708 in patients with systemic lupus erythematosus (n = 39), 1.2 45 and 0.935-1.660 in patients with nephrosclerosis (n = 122), 1.815 a nd 1.447-2.229 in patients with diabetes mellitus (n = 374), and 1.595 and 1.201-2.117, respectively, in patients with other renal diseases (n = 146) when the HR in patients with chronic glomerulonephritis (n = 1,263) was taken as 1.00. HR and 95% confidence intervals were 1.222 and 1.016-1.470 in patients with one comorbid condition (n = 217) and 1.494 and 1.033-2.160, respectively, in patients with two comorbid con ditions (n = 24) when the HR of patients with no predialysis comorbid conditions (n = 1,741) was taken as 1.00. Our data demonstrate the eff ects of renal diseases and number of predialysis comorbid conditions o n the survival in chronic dialysis patients. Differences in proportion of diabetic patients and age at entry may cause large differences in survival rates. In diabetic patients, causes of malnutrition and the e ffects of dialysis dose on the survival rate remain to determined.