title: Mortality in chronic kidney disease and renal replacement therapy: a population-based cohort study.
abstract: OBJECTIVE
  To compare mortality in chronic kidney disease (CKD) stages 4 and 5 (estimated glomerular filtration rate <30 mL/min/1.73 m(2)), peritoneal dialysis, haemodialysis and transplanted patients.
  
  
  METHODS
  Population-based cohort study.
  
  
  METHODS
  Swedish national healthcare system.
  
  
  METHODS
  Swedish adult patients with CKD stages 4 and 5 (n=3040; mean age 66 years), peritoneal dialysis (n=725; 60 years), haemodialysis (n=1791; 62 years) and renal transplantation (n=606; 48 years) were identified in Stockholm County clinical quality registers for renal disease between 1999 and 2010. Five general population controls were matched to each patient by age, sex and index year.
  
  
  METHODS
  CKD status (stage 4 or 5/peritoneal dialysis/haemodialysis/transplanted).
  
  
  METHODS
  All-cause mortality was ascertained from the Swedish Causes of Death Register. Mortality HRs were estimated using Cox regression conditioned on age, sex, diabetes status, education level and index year.
  
  
  RESULTS
  During 6553 person-years, 766 patients with CKD stages 4 and 5 died (deaths/100 person-years 12, 95% CI 11 to 13) compared with 186 deaths during 1113 person-years in peritoneal dialysis (17, 95% CI 15 to 19), 924 deaths during 3680 person-years in haemodialysis (25, 95% CI 23 to 27) and 53 deaths during 2935 person-years in transplanted patients (1.8, 95% CI 1.4 to 2.4). Against matched general population controls, the mortality HR was 3.6 (95% CI 3.2 to 4.0) for CKD, 5.6 (95% CI 3.5 to 8.9) for transplanted patients, 9.2 (95% CI 6.6 to 12.7) for peritoneal dialysis and 12.6 (95% CI 10.8 to 14.6) for haemodialysis. In direct comparison versus CKD, the mortality HR was 1.7 (95% CI 1.4 to 2.1) for peritoneal dialysis, 2.6 (95% CI 2.3 to 2.9) for haemodialysis and 0.5 (95% CI 0.3 to 0.7) for transplanted patients.
  
  
  CONCLUSIONS
  We did not find support for mortality in CKD to be similar to dialysis mortality. The patients with CKD stages 4 and 5 had considerably lower mortality risk than dialysis patients, and considerably higher risk than transplanted patients and matched general population controls.
authors.affiliation: Clinical Epidemiology Unit, Department of Medicine, Karolinska Institutet, Stockholm, Sweden.
authors.forename: Martin
authors.initials: M
authors.lastname: Neovius
authors.forename: Stefan H
authors.initials: SH
authors.lastname: Jacobson
authors.forename: Jonas K
authors.initials: JK
authors.lastname: Eriksson
authors.forename: Carl-Gustaf
authors.initials: CG
authors.lastname: Elinder
authors.forename: Britta
authors.initials: B
authors.lastname: Hylander
mesh_terms: D000368:Aged; D002423:Cause of Death; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D007676:Kidney Failure, Chronic / Q000401:mortality* / Q000628:therapy*; D016030:Kidney Transplantation / Q000401:mortality; D008297:Male; D010530:Peritoneal Dialysis / Q000401:mortality; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality; D017582:Renal Replacement Therapy / Q000401:mortality*; D013548:Sweden
keywords: chronic kidney disease; mortality; renal replacement therapy; transplantation