Abstract: FR-PO805

World-Wide Early Mortality Rates after Commencement of Hemodialysis: A Systematic Review and Meta-Analysis

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Hazara, Adil Mohammad, Hull and East Yorkshire Hospitals NHS Trust, Hull, Hull, United Kingdom
  • Bhandari, Sunil, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, East Yorkshire, Hull, United Kingdom
Background

In the care of patients with progressive decline in renal function, the start of maintenance hemodialysis (HD) marks a critical turning point. Mortality rates are reported to be high in this period due to multiple treatment and patient related factors. Our aim was to estimate world-wide early mortality rates after commencement of HD in patients with end-stage renal disease.

Methods

Medline and EMBASE were searched for studies published between 1/1/1985 and 7/31/2015 in English. Early mortality was defined as deaths within 180 days of starting HD. Case-control and cohort studies involving adult subjects commencing HD were included. Number of deaths within the early period were extracted and converted in to annualised mortality rates (expressed in 100 person-year). The Quality in Prognosis Studies tool was used to assess risk of bias in studies.

Results

25 studies were included (population of 1,000,014 patients from 12 countries). Median follow-up: 90 days representing 255,079 person-years of observation. Mortality rates varied from 15.7 to 122.0 per 100 person-year (meta-analysis: 31.6 per 100 person-year [95% CI 31.0-32.2], figure 1). Rates were highest in studies based in Africa (87.2 vs Europe: 15.9 per 100 person-year), lower income countries (87.2 vs high income countries: 31.5 per 100 person-year), studies that restricted recruitment to elderly (37.5 vs unselected: 31.6 per 100 person-year), those that started recruiting in earlier decades (1970’s: 37.3 vs 2000’s: 31.6 per 100 person-year) and those with low risk of bias (33.6 vs high risk: 22.6 per 100 person-year).

Conclusion

High rates of early mortality after commencement of HD is a global phenomenon. Studies showing lowest rates generally carried high risk of bias suggesting likely under-reporting and incomplete follow-up.

Figure 1: Meta-analysis of early mortality rates in patients newly started on hemodialysis