Comparison of Turkish and US haemodialysis patient mortality rates: an observational cohort study.
BACKGROUND
There are significant differences between countries in the mortality rates of haemodialysis (HD) patients. The extent of these differences and possible contributing factors are worthy of investigation.


METHODS
As of March 2009, all patients undergoing HD or haemodiafiltration for >3 months (n = 4041) in the Turkish clinics of the NephroCare network were enrolled. Data were prospectively collected for 2 years through the European Clinical Dialysis Database. Mean age ± standard deviation was 58.7 ± 14.7 years, 45.9% were female and 22.9% were diabetic. Comparison with US data was performed by applying an indirect standardization technique, using specific mortality rates for patients on HD by age, gender, race and primary diagnosis as provided by the 2012 US Renal Data System Annual Data Report as reference.


RESULTS
The crude mortality rate in Turkey was 95.1 per 1000 patient-years. Compared with the US reference population, the annual mortality rate for Turkey was significantly lower, irrespective of gender, age and diabetes. After adjustments for age, gender and diabetes, the mortality risk in the Turkish cohort was 50% lower than US whites [95% confidence interval (CI) 0.46-0.54, P < 0.001], 44% lower than US African-Americans (95% CI 0.52-0.61, P < 0.001) and 20% lower than Asian-Americans (95% CI 0.74-0.86, P < 0.05).


CONCLUSIONS
The annual mortality rate of prevalent HD patients was found to be significantly lower in the studied Turkish cohort compared with that published by the US Renal Data System Annual Data Report. Differences in practice patterns may contribute to the divergence.
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Gulay
G
Asci
Fresenius Medical Care , Bad Homburg, Hessen , Germany.
Daniele
D
Marcelli
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Aygul
A
Celtik
Fresenius Medical Care , Bad Homburg, Hessen , Germany.
Aileen
A
Grassmann
Fresenius Medical Care , Istanbul , Turkey.
Kutay
K
Gunestepe
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Mustafa
M
Yaprak
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Abdulkerim Furkan
AF
Tamer
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Mehmet Nuri
MN
Turan
Division of Nephrology , Istanbul University School of Medicine , Istanbul , Turkey.
Mehmet Sukru
MS
Sever
Division of Nephrology , Ege University School of Medicine , Bornova, Izmir , Turkey.
Ercan
E
Ok
Turkey; haemodiafiltration; haemodialysis; mortality; practice patterns