LONG-TERM SURVIVAL IN END-STAGE RENAL-DISEASE

Despite improvements in dialysis technology and overall improvements i n healthcare, the mortality rate of end-stage renal disease (ESRD) pat ients in the United States remains high-at 21.3% in 1995.(1) Inadequat e dialysis, malnutrition, and other serious comorbid conditions may al l contribute to the high mortality rate in dialysis patients. The high mortality rate of ESRD patients has prompted investigators to examine causes and predictors of mortality in these patients. Some of these p redictors include demographic and clinical characteristics such as age , race, gender, and diabetic status; nutritional status as evaluated b y albumin, pre-albumin, creatinine, cholesterol and, more recently, pa rathyroid hormone (PTH) levels; dialytic factors such as the dose of d ialysis; and assessed functional health status.(2-7) This article look s at the relative significance of these predictors as determined by th e authors through clinical studies and insights gained through their o wn long-term successes. The authors encourage analysis of outlier pati ents in order to garner clues to prolonged survival.