Influence of coexisting disease on survival on renal-replacement therapy
Survival of patients on renal-replacement therapy (RRT) is no longer improving. Increasingly, such patients are older and have co-morbid conditions affecting organs other than the kidney. In a retrospective study, we calculated actuarial survival of 375 patients starting RRT during a 61/2 year perio...
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| Veröffentlicht in: | The Lancet (British edition) 1993-02, Vol.341 (8842), p.415-418 |
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| creator | Khan, I.H. Catto, G.R.D. MacLeod, A.M. Edward, N. Fleming, L.W. Henderson, I.S. |
| description | Survival of patients on renal-replacement therapy (RRT) is no longer improving. Increasingly, such patients are older and have co-morbid conditions affecting organs other than the kidney.
In a retrospective study, we calculated actuarial survival of 375 patients starting RRT during a 61/2 year period at renal units in Aberdeen and Dundee, UK, after stratification of patients into three risk groups (low, medium, and high) based predominantly on co-morbidity and to a lesser extent on age. 2-year survival differed significantly between low, medium, and high risk groups both before (86%, 60%, and 35%, respectively; p < 0·002 for all comparisons) and after (90%, 70%, 46%; p < 0·004 for all comparisons) excluding early deaths (within 90 days of starting RRT). Overall survival was 61 % in Aberdeen and 68% in Dundee (p=0·04), but 73% and 74%, respectively, when deaths in the first 90 days were excluded (p=0·73).
We conclude that RRT is a highly successful treatment (86% 2-year survival) for patients aged under 70 with no co-morbid conditions (low-risk group); that coexisting non-renal disease has an important influence on survival of patients on RRT; and that risk stratification and analysis of data including and excluding early deaths should allow more valid comparison of data from different centres. |
| doi_str_mv | 10.1016/0140-6736(93)93003-J |
| format | Article |
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In a retrospective study, we calculated actuarial survival of 375 patients starting RRT during a 61/2 year period at renal units in Aberdeen and Dundee, UK, after stratification of patients into three risk groups (low, medium, and high) based predominantly on co-morbidity and to a lesser extent on age. 2-year survival differed significantly between low, medium, and high risk groups both before (86%, 60%, and 35%, respectively; p < 0·002 for all comparisons) and after (90%, 70%, 46%; p < 0·004 for all comparisons) excluding early deaths (within 90 days of starting RRT). Overall survival was 61 % in Aberdeen and 68% in Dundee (p=0·04), but 73% and 74%, respectively, when deaths in the first 90 days were excluded (p=0·73).
We conclude that RRT is a highly successful treatment (86% 2-year survival) for patients aged under 70 with no co-morbid conditions (low-risk group); that coexisting non-renal disease has an important influence on survival of patients on RRT; and that risk stratification and analysis of data including and excluding early deaths should allow more valid comparison of data from different centres.</description><identifier>ISSN: 0140-6736</identifier><identifier>EISSN: 1474-547X</identifier><identifier>DOI: 10.1016/0140-6736(93)93003-J</identifier><identifier>PMID: 8094182</identifier><identifier>CODEN: LANCAO</identifier><language>eng</language><publisher>London: Elsevier Ltd</publisher><subject>Adolescent ; Adult ; Aged ; Aged, 80 and over ; Biological and medical sciences ; Child ; Comorbidity ; Data processing ; Fatalities ; Female ; Health risk assessment ; Humans ; Kidney Failure, Chronic - complications ; Kidney Failure, Chronic - therapy ; Kidney Transplantation - mortality ; Kidneys ; Male ; Medical disorders ; Medical research ; Medical sciences ; Middle Aged ; Morbidity ; Organs ; Patients ; Renal Dialysis - mortality ; Retrospective Studies ; Risk analysis ; Risk groups ; Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases ; Surgery of the urinary system ; Survival ; Survival Rate ; Therapy</subject><ispartof>The Lancet (British edition), 1993-02, Vol.341 (8842), p.415-418</ispartof><rights>1993</rights><rights>1993 INIST-CNRS</rights><rights>Copyright Lancet Ltd. Feb 13, 1993</rights><rights>Copyright Elsevier Limited Feb 13, 1993</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c507t-b00c79ddaa24fe463018960cdabc3a452196ad5426894f8c0b81f6d1075fad8a3</citedby><cites>FETCH-LOGICAL-c507t-b00c79ddaa24fe463018960cdabc3a452196ad5426894f8c0b81f6d1075fad8a3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktohtml>$$Uhttps://www.sciencedirect.com/science/article/pii/014067369393003J$$EHTML$$P50$$Gelsevier$$H</linktohtml><link.rule.ids>314,776,780,3537,27901,27902,65306</link.rule.ids><backlink>$$Uhttp://pascal-francis.inist.fr/vibad/index.php?action=getRecordDetail&idt=4633398$$DView record in Pascal Francis$$Hfree_for_read</backlink><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/8094182$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>Khan, I.H.</creatorcontrib><creatorcontrib>Catto, G.R.D.</creatorcontrib><creatorcontrib>MacLeod, A.M.</creatorcontrib><creatorcontrib>Edward, N.</creatorcontrib><creatorcontrib>Fleming, L.W.</creatorcontrib><creatorcontrib>Henderson, I.S.</creatorcontrib><title>Influence of coexisting disease on survival on renal-replacement therapy</title><title>The Lancet (British edition)</title><addtitle>Lancet</addtitle><description>Survival of patients on renal-replacement therapy (RRT) is no longer improving. Increasingly, such patients are older and have co-morbid conditions affecting organs other than the kidney.
In a retrospective study, we calculated actuarial survival of 375 patients starting RRT during a 61/2 year period at renal units in Aberdeen and Dundee, UK, after stratification of patients into three risk groups (low, medium, and high) based predominantly on co-morbidity and to a lesser extent on age. 2-year survival differed significantly between low, medium, and high risk groups both before (86%, 60%, and 35%, respectively; p < 0·002 for all comparisons) and after (90%, 70%, 46%; p < 0·004 for all comparisons) excluding early deaths (within 90 days of starting RRT). Overall survival was 61 % in Aberdeen and 68% in Dundee (p=0·04), but 73% and 74%, respectively, when deaths in the first 90 days were excluded (p=0·73).
We conclude that RRT is a highly successful treatment (86% 2-year survival) for patients aged under 70 with no co-morbid conditions (low-risk group); that coexisting non-renal disease has an important influence on survival of patients on RRT; and that risk stratification and analysis of data including and excluding early deaths should allow more valid comparison of data from different centres.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Aged</subject><subject>Aged, 80 and over</subject><subject>Biological and medical sciences</subject><subject>Child</subject><subject>Comorbidity</subject><subject>Data processing</subject><subject>Fatalities</subject><subject>Female</subject><subject>Health risk assessment</subject><subject>Humans</subject><subject>Kidney Failure, Chronic - complications</subject><subject>Kidney Failure, Chronic - therapy</subject><subject>Kidney Transplantation - mortality</subject><subject>Kidneys</subject><subject>Male</subject><subject>Medical disorders</subject><subject>Medical research</subject><subject>Medical sciences</subject><subject>Middle Aged</subject><subject>Morbidity</subject><subject>Organs</subject><subject>Patients</subject><subject>Renal Dialysis - mortality</subject><subject>Retrospective Studies</subject><subject>Risk analysis</subject><subject>Risk groups</subject><subject>Surgery (general aspects). 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Academic</collection><jtitle>The Lancet (British edition)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Khan, I.H.</au><au>Catto, G.R.D.</au><au>MacLeod, A.M.</au><au>Edward, N.</au><au>Fleming, L.W.</au><au>Henderson, I.S.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Influence of coexisting disease on survival on renal-replacement therapy</atitle><jtitle>The Lancet (British edition)</jtitle><addtitle>Lancet</addtitle><date>1993-02-13</date><risdate>1993</risdate><volume>341</volume><issue>8842</issue><spage>415</spage><epage>418</epage><pages>415-418</pages><issn>0140-6736</issn><eissn>1474-547X</eissn><coden>LANCAO</coden><abstract>Survival of patients on renal-replacement therapy (RRT) is no longer improving. Increasingly, such patients are older and have co-morbid conditions affecting organs other than the kidney.
In a retrospective study, we calculated actuarial survival of 375 patients starting RRT during a 61/2 year period at renal units in Aberdeen and Dundee, UK, after stratification of patients into three risk groups (low, medium, and high) based predominantly on co-morbidity and to a lesser extent on age. 2-year survival differed significantly between low, medium, and high risk groups both before (86%, 60%, and 35%, respectively; p < 0·002 for all comparisons) and after (90%, 70%, 46%; p < 0·004 for all comparisons) excluding early deaths (within 90 days of starting RRT). Overall survival was 61 % in Aberdeen and 68% in Dundee (p=0·04), but 73% and 74%, respectively, when deaths in the first 90 days were excluded (p=0·73).
We conclude that RRT is a highly successful treatment (86% 2-year survival) for patients aged under 70 with no co-morbid conditions (low-risk group); that coexisting non-renal disease has an important influence on survival of patients on RRT; and that risk stratification and analysis of data including and excluding early deaths should allow more valid comparison of data from different centres.</abstract><cop>London</cop><pub>Elsevier Ltd</pub><pmid>8094182</pmid><doi>10.1016/0140-6736(93)93003-J</doi><tpages>4</tpages></addata></record> |
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| subjects | Adolescent Adult Aged Aged, 80 and over Biological and medical sciences Child Comorbidity Data processing Fatalities Female Health risk assessment Humans Kidney Failure, Chronic - complications Kidney Failure, Chronic - therapy Kidney Transplantation - mortality Kidneys Male Medical disorders Medical research Medical sciences Middle Aged Morbidity Organs Patients Renal Dialysis - mortality Retrospective Studies Risk analysis Risk groups Surgery (general aspects). Transplantations, organ and tissue grafts. Graft diseases Surgery of the urinary system Survival Survival Rate Therapy |
| title | Influence of coexisting disease on survival on renal-replacement therapy |
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