title: [Changes in the prognosis for survival of patients with end-stage renal disease (ESRD) treated by hemodialysis].
abstract: We started dialysis treatment in our institution in 1966, and have improved hemodialysis (HD) treatment through the induction of a biocompatible dialysis membrane, recombinant human erythropoietin, activated vitamin D and purification of the dialysate. We verified improvement of the prognosis for survival of patients with ESRD during this forty-year period, retrospectively. A total of 1,690 patients who began dialysis therapy in our hospital between January 1966 and December 2005 was studied (men: 1,047, women: 643, age: 58.6 +/- 17.4 years. They were divided into four groups (A: patients who started dialysis in the period from 1966 to 1975; n = 280, B: 1976-1985; n = 455, C: 1986-1995; n = 499, D: 1996-2005; n = 456). The mean follow-up period was 8.48 +/- 8.53 years. Of the patients 1,588 were treated with HD, 78 with peritoneal dialysis (PD), and 24 with PD or HD. Age at the initiation of dialysis increased gradually (A: 40.1 +/- 14.2 y-o, B: 53.2 +/- 15.8 y-o, C: 60.0 +/- 16.0 y-o, D: 66.4 +/- 13.8 y-o), and diabetics increased (A: 6.4%, B: 19.5%, C: 25.6%, D: 33.4%). A total of 1,180 patients died; 48.5% of these patients died of cardiovascular disease, 21.3% of infectious disease, and 6.4% of malignancy. Only 13 patients had kidney-transplants. With the Cox proportional hazard model for HD cases, age at the initiation of dialysis, gender, cause of renal disease, and the periods were significant predictors of mortality. The relative risk of mortality compared with that in A was reduced progressively: 0.796 in period B (95% confidence interval [CI]: 0.659-0.961, p = 0.0178), 0.505 in period C (95% CI: 0.409-0.623, p < 0.0001), and 0.286 in period D (95% CI: 0.223-0.366, p < 0.0001).
  
  
  CONCLUSIONS
  Although the number of high-aged patients or diabetics with ESRD increased in these 40 years, the survival of the patients with ESRD improved.
authors.affiliation: Kidney Center of Shinraku-en Hospital, Niigata, Japan.
authors.forename: Tai
authors.initials: T
authors.lastname: Sakurabayashi
authors.forename: Hiroshi
authors.initials: H
authors.lastname: Kikuchi
authors.forename: Hitoshi
authors.initials: H
authors.lastname: Nakayama
authors.forename: Yutaka
authors.initials: Y
authors.lastname: Osawa
authors.forename: Hisaki
authors.initials: H
authors.lastname: Shimada
authors.forename: Shigeru
authors.initials: S
authors.lastname: Miyazaki
authors.forename: Yasuko
authors.initials: Y
authors.lastname: Yuasa
authors.forename: Shinji
authors.initials: S
authors.lastname: Sakai
authors.forename: Masashi
authors.initials: M
authors.lastname: Suzuki
authors.forename: Sachio
authors.initials: S
authors.lastname: Takahashi
authors.forename: Yoshihei
authors.initials: Y
authors.lastname: Hirasawa
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D004921:Erythropoietin / Q000627:therapeutic use; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D011994:Recombinant Proteins; D006435:Renal Dialysis; D012737:Sex Factors; D015996:Survival Rate; D014807:Vitamin D / Q000627:therapeutic use
chemical_list: D011994:Recombinant Proteins; D004921:Erythropoietin; D014807:Vitamin D