Long-term survival and predictors for mortality among dialysis patients in an endemic area for chronic liver disease: a national cohort study in Taiwan.
BACKGROUND
Patients with end-stage renal disease (ESRD) are at a higher risk for chronic hepatitis, liver cirrhosis (LC) and mortality than the general population. Optimal modalities of renal replacement therapy for ESRD patients with concomitant end-stage liver disease remain controversial. We investigated the long-term outcome for chronic liver disease among dialysis patients in an endemic area.


METHODS
Using Taiwan's National Health Insurance claim data (NHRI-NHIRD-99182), We performed a longitudinal cohort study to investigate the impact of comorbidities on mortality in dialysis patients. We followed up 11293 incident hemodialysis (HD) and 761 peritoneal dialysis (PD) patients from the start of dialysis until the date of death or the end of database period (December 31, 2008). A Cox proportional hazards model was used to identify the risk factors for all-cause mortality.


RESULTS
Patients receiving PD tended to be younger and less likely to have comorbidities than those receiving HD. At the beginning of dialysis, a high prevalence rate (6.16 %) of LC was found. Other than well-known risk factors, LC (hazard ratio [HR] 1.473, 95 % CI: 1.329-1.634) and dementia (HR 1.376, 95 % CI: 1.083-1.750) were also independent predictors of mortality. Hypertension and mortality were inversely associated. Dialysis modality and three individual comorbidities (diabetes mellitus, chronic lung disease, and dementia) interacted significantly on mortality risk.


CONCLUSIONS
LC is an important predictor of mortality; however, the effect on mortality was not different between HD and PD patients.
Department of Nephrology, Chi-Mei Medical Center, No,901, Zhonghua Rd, Tainan City, Yongkang Dist 710, Taiwan.
Chih-Chiang
CC
Chien
Jhi-Joung
JJ
Wang
Yih-Min
YM
Sun
Ding-Ping
DP
Sun
Ming-Jen
MJ
Sheu
Shih-Feng
SF
Weng
Chin-Chen
CC
Chu
Hung-An
HA
Chen
Chung-Ching
CC
Chio
Jyh-Chang
JC
Hwang
Yi-Hua
YH
Lu
Hsien-Yi
HY
Wang
Wei-Chih
WC
Kan
D000293:Adolescent; D000328:Adult; D000368:Aged; D015331:Cohort Studies; D058625:End Stage Liver Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D019353:Endemic Diseases; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008137:Longitudinal Studies; D008297:Male; D008875:Middle Aged; D011237:Predictive Value of Tests; D006435:Renal Dialysis / Q000401:mortality* / Q000639:trends; D015996:Survival Rate / Q000639:trends; D013624:Taiwan / Q000453:epidemiology; D013997:Time Factors; D055815:Young Adult