Early Mortality Was Highly and Strongly Associated with Functional Status in Incident Japanese Hemodialysis Patients: A Cohort Study of the Large National Dialysis Registry.
BACKGROUND
Although dialysis is typically started in an effort to prolong survival, mortality is reportedly high in the first few months. However, it remains unclear whether this is true in Japanese patients who tend to have a better prognosis than other ethnicities, and if health conditions such as functional status (FS) at initiation of dialysis influence prognosis.


METHODS
We investigated the epidemiology of early death and its association with FS using Japanese national registry data in 2007, which included 35,415 patients on incident dialysis and 7,664 with FS data. The main outcome was early death, defined as death within 3 months after initiation of hemodialysis (HD). The main predictor was FS at initiation of HD. Levels of functional disability were categorized as follows: severe (bedridden), moderate (overt difficulties in exerting basic activities of daily living), or mild/none (none or some functional disabilities).


RESULTS
Early death remained relatively common, especially among elderly patients (overall: 7.1%; those aged ≥80 years: 15.8%). Severely and even only a moderately impaired FS were significantly associated with early death after starting dialysis (adjusted risk ratios: 3.93 and 2.38, respectively). The incidence of early death in those with impaired FS increased with age (36.5% in those with severely impaired FS and aged ≥80 years).


CONCLUSIONS
Early death after starting dialysis was relatively common, especially among the elderly, even in Japanese patients. Further, early death was significantly associated with impaired FS at initiation of HD.
Division of Nephrology and Hypertension, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Masahiko
M
Yazawa
Institute for Health Outcomes and Process Evaluation Research (iHope International), Kyoto, Japan.
Ryo
R
Kido
Sapporo Kita Clinic, Sapporo, Hokkaido, Japan.
Seiji
S
Ohira
Center for Innovative Research for Communities and Clinical Excellence, Fukushima Medical University, Fukushima, Japan.
Takeshi
T
Hasegawa
Division of Total Renal Care Medicine, The University of Tokyo Hospital, Tokyo, Japan.
Norio
N
Hanafusa
The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
Kunitoshi
K
Iseki
The Committee of Renal Data Registry, Japanese Society for Dialysis Therapy, Tokyo, Japan.
Yoshiharu
Y
Tsubakihara
Division of Nephrology and Hypertension, St Marianna University School of Medicine, Kawasaki, Kanagawa, Japan.
Yugo
Y
Shibagaki
D000368:Aged; D000369:Aged, 80 and over; D015331:Cohort Studies; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000401:mortality / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D011379:Prognosis; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D015996:Survival Rate