Analysis of patients dying within one year of starting renal replacement therapy.
BACKGROUND
The annual gross mortality of end-stage renal failure patients remains very high (approximately 15-20%) leading some to question the wisdom of accepting patients with limited prognosis for dialysis. We have reviewed the demographic and clinical characteristics of patients who died within a year of commencing renal replacement therapy (RRT) over a 5-year period to establish whether these patients could be identified at the start of therapy.


METHODS
Case notes of patients who died within 1 year of commencing RRT between 1st April, 1991 and 31st March, 1996 were reviewed. Comorbidity at the start of dialysis was used to classify patients into high-, medium- and low-risk groups using two published scales to determine whether either graded a high proportion of deaths as high risk. Factors such as age, social circumstances, cause of death, renal diagnosis and mode of dialysis were also analysed.


RESULTS
17.5% of patients commencing RRT died in the first year. Not all of these patients could be identified as high risk by comorbidity assessment at dialysis initiation - 50% of patients who died were classified by one scale as medium risk. Age did not clearly predict outcome, as 42% of patients who died were less than 65 years old.


CONCLUSIONS
These data suggest that it is difficult to use current risk stratifications to accurately predict outcome on RRT.
Walters
G
G
Department of Nephrology, Leicester General Hospital, Leicester, UK.
Warwick
G
G
Walls
J
J
D000293:Adolescent; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002423:Cause of Death; D015897:Comorbidity; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D017582:Renal Replacement Therapy / Q000379:methods / Q000401:mortality*; D013997:Time Factors; D006113:United Kingdom