title: Different impact of hemodialysis vintage on cause-specific mortality in long-term hemodialysis patients.
abstract: BACKGROUND
  Although dialysis vintage is associated with increased mortality risk in patients receiving hemodialysis (HD), the association of dialysis vintage with cause-specific mortality is unclear.
  
  
  METHODS
  We conducted a nationwide registry-based retrospective cohort study of 216 246 patients receiving maintenance HD for > 1 year at the end of 2009. The associations of dialysis vintage categories (1 -< 2, 2 -< 5, 5 -< 10, 10 -< 15, 15 -< 20, 20 -< 25, 25 -< 30 and ≥ 30 years) with 1-year all-cause and cause-specific mortality, including cardiovascular diseases (CVDs) and infection-related mortality, were examined using logistic regression models.
  
  
  RESULTS
  During the 1-year study period, 18 614 deaths occurred from all causes, including 7263 and 3504 deaths from CVD and infection-related causes. From multivariate analysis, the dialysis vintage was incrementally associated with a higher risk for all-cause mortality, with worse outcome observed in the ≥ 30 years category {odds ratio [OR] = 2.43 (95% confidence interval (CI) 2.13-2.77}. A similar association was apparent between the dialysis vintage and infection-related mortality, with a higher risk than that of all-cause mortality in each vintage category [≥ 30 years, OR = 3.55 (95% CI 2.72-4.66)], while the dialysis vintage was associated with only a modest increase in risk of CVD mortality [≥ 30 years, OR = 1.64 (95% CI 1.30-2.08)].
  
  
  CONCLUSIONS
  Dialysis vintage has a different impact on cause-specific mortality, with a higher risk for infection-related mortality than CVD mortality. This impact is most pronounced in long-term HD survivors, to whom much attention should be devoted to prevent infectious complications.
authors.affiliation: Nephrology Center, Toranomon Hospital Kajigaya, Kanagawa, Japan.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Kunihiro
authors.initials: K
authors.lastname: Yamagata
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Kunitoshi
authors.initials: K
authors.lastname: Iseki
authors.affiliation: Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
authors.forename: Yoshiharu
authors.initials: Y
authors.lastname: Tsubakihara
mesh_terms: D000293:Adolescent; D000328:Adult; D002318:Cardiovascular Diseases / Q000209:etiology* / Q000401:mortality; D002423:Cause of Death / Q000639:trends; D002648:Child; D002675:Child, Preschool; D005260:Female; D006801:Humans; D007223:Infant; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000150:complications / Q000401:mortality / Q000628:therapy*; D008297:Male; D012042:Registries; D006435:Renal Dialysis; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends; D055815:Young Adult
keywords: cardiovascular disease (CVD); dialysis vintage; hemodialysis (HD); infection; mortality