Profile of hospitalisation and death in the first year after diagnosis of end-stage renal disease in a multi-ethnic Asian population.
BACKGROUND
The increasing prevalence of end-stage renal disease (ESRD) is an important public health issue due to the high costs of kidney replacement therapies. We examined the impact of ethnicity and other factors in ESRD management and hospitalisation in a multiracial Asian population in the fi rst year after diagnosis.


METHODS
We analysed a prospectively collected database of 168 new ESRD patients from the National University Hospital, Singapore (NUH) in 2005. Univariate and multivariate analyses were performed to assess factors for mortality and hospitalisation.


RESULTS
Sixteen patients eventually chose conservative treatment, 102 haemodialysis, 41 peritoneal dialysis and 9 patients underwent kidney transplantation for their long-term treatment. Although more Chinese patients had dialysis plans (56.7% vs 36.8%, P = 0.022), many still required urgent dialysis initiation via catheters (61.3%). These dialysed patients who required urgent treatment had more admissions (3.6 vs 2.6, P = 0.023) and longer length of stay (9.3 days, P = 0.014). Approximately 40 (7.4%) admissions were related to vascular access complications (thromboses, dislodgements and infections), and 15 (2.8%) were for new tunnelled catheter insertions. Deaths were 23.8% in the fi rst year after diagnosis and median survival was 125 days. Age, fi nal treatment modality, type of therapy centre, history of coronary artery disease, left ventricular ejection fraction (LVEF) <50%, and having no plans for dialysis were associated with mortality.


CONCLUSIONS
The care of ESRD patients requires substantial commitment of healthcare resources particularly in the fi rst year after diagnosis. Steps to reduce urgent initiation of dialysis will help reduce resource utilisation and improve patient outcomes.
Teo
Boon Wee
BW
Department of Medicine, Yong Loo Lin School of Medicine, National University of Singapore, Singapore. mdctbw@nus.edu.sg
Ma
Valerie
V
Xu
Hui
H
Li
Jialiang
J
Lee
Evan J
EJ
D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D019992:Databases as Topic; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000208:ethnology* / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D010358:Patient Participation; D011446:Prospective Studies; D006435:Renal Dialysis; D012846:Singapore / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult