title: Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: a population-based study.
abstract: BACKGROUND
  Patients with end-stage renal disease (ESRD(Pos)) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure.
  
  
  METHODS
  The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD(Neg)) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD(Pos) patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD(Neg) patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV.
  
  
  RESULTS
  The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD(Pos) patients than in ESRD(Neg) patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality.
  
  
  CONCLUSIONS
  ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.
authors.affiliation: Department of Recreation and Health-Care Management, Chia Nan University of Pharmacy and Science, No.60, Sec. 1, Erren Road., Rende District, Tainan, 71710, Taiwan. chencm3383@yahoo.com.tw.|Southern Taiwan University of Science and Technology, No. 1, Nan-Tai Street, Yungkang District, Tainan, 710, Taiwan. chencm3383@yahoo.com.tw.|Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. chencm3383@yahoo.com.tw.
authors.forename: Chin-Ming
authors.initials: CM
authors.lastname: Chen
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying District, 201, Taikang, Taikang Village, Liouying District, Tainan, 736, Taiwan. dtmed141@gmail.com.
authors.forename: Chih-Cheng
authors.initials: CC
authors.lastname: Lai
authors.affiliation: Department of Internal Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. kuochen@ms1.hinet.net.|Department of Safety, Health and Environment, Chung Hwa University of Medical Technology, 89, Wenhua 1st Street, Rende District, Tainan, 717, Taiwan. kuochen@ms1.hinet.net.
authors.forename: Kuo-Chen
authors.initials: KC
authors.lastname: Cheng
authors.affiliation: Department of Hospital and Health Care Administration, Chia Nan University of Pharmacy and Science, Tainan, Taiwan. also99@gmail.com.|Department of Healthcare Administration and Medical Informatics, Kaohsiung Medical University, Kaohsiung, Taiwan. also99@gmail.com.
authors.forename: Shih-Feng
authors.initials: SF
authors.lastname: Weng
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. medrpeterliu@gmail.com.|Department of Intensive Care Medicine, Chi Mei Medical Center, Liouying District, 201, Taikang, Taikang Village, Liouying District, Tainan, 736, Taiwan. medrpeterliu@gmail.com.
authors.forename: Wei-Lun
authors.initials: WL
authors.lastname: Liu
authors.affiliation: Department of Intensive Care Medicine, Chi Mei Medical Center, 901 Chung Hwa Road, Yungkang District, Tainan, 710, Taiwan. hsiunian@gmail.com.|Department of Public Health, College of Medicine, National Cheng Kung University, 1, University Road, Tainan, 701, Taiwan. hsiunian@gmail.com.
authors.forename: Hsiu-Nien
authors.initials: HN
authors.lastname: Shen
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D015897:Comorbidity; D005260:Female; D017052:Hospital Mortality / Q000639:trends*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality; D012121:Respiration, Artificial / Q000009:adverse effects / Q000401:mortality* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D012307:Risk Factors; D017741:Survivors / Q000706:statistics & numerical data*; D013624:Taiwan / Q000453:epidemiology