What happens to patients starting dialysis in the Netherlands?
BACKGROUND
despite improvements in dialysis technology, publications around 1990 showed increasing mortality rates in dialysis patients. The Dialysis Group of the Netherlands initiated the Netherlands Cooperative Study on the Adequacy of Dialysis (NECOSAD) to investigate the association of patient and therapy characteristics with outcome.


METHODS
250 patients were included in this prospective multicentre study 3 months after the start of dialysis. We used Cox regression to predict mortality and technique failure and repeated measures analysis of variance to study the time course of continuous parameters.


RESULTS
there were considerable differences in patient populations among dialysis centres. Patient survival was 76% at 2 years. Technique survival was higher in haemodialysis. Hospitalisation decreased from 25 days between 3 and 12 months to 19 days per patient year in the third year. Residual renal function decreased at a similar rate in both modalities, but blood pressure tended to increase in females receiving peritoneal dialysis. Outcome was predominantly dependent on patient characteristics.


CONCLUSIONS
In the light of the increasing age of patients starting dialysis, increasing mortality can be expected. Furthermore, if outcome is to play a role in the quality assessment of dialysis centres, it is essential to know the characteristics of their patient populations.
Jager
K J
KJ
Department of Nephrology, Academic Medical Center, University of Amsterdam, Amsterdam, The Netherlands.
Merkus
M P
MP
Boeschoten
E W
EW
Dekker
F W
FW
Tijssen
J G
JG
Krediet
R T
RT
D000367:Age Factors; D000368:Aged; D015897:Comorbidity; D005260:Female; D006760:Hospitalization; D006801:Humans; D007668:Kidney / Q000502:physiology; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010530:Peritoneal Dialysis / Q000009:adverse effects / Q000401:mortality*; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D006435:Renal Dialysis / Q000009:adverse effects / Q000401:mortality*; D016019:Survival Analysis; D016896:Treatment Outcome