Pre-ESRD Care Cuts Early Mortality

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In the first year after starting dialysis, death risk is highest in the first 120 days, study shows.
 
Patients with end-stage renal disease (ESRD) are at higher risk of death within the first 120 days of  hemodialysis compared with 121-365 days after hemodialysis initiation, according to a report. This elevated risk is strongly associated with the absence of pre-ESRD nephrology care.

The findings come from a study of 4,802 hemodialysis patients who participated in the Dialysis Outcomes and Practice Patterns Study. The study population had 27.5 deaths per 100 person-years during the first 120 days after starting dialysis compared with 21.9 deaths per 100 person-years in the subsequent 121-365 days after dialysis initiation.

Patients who had received pre-ESRD nephrology care—defined as having been seen by a nephrologist more than 30 days prior to starting dialysis—had a 35% lower risk of death during the first 120 days compared with patients who did not have this care, the investigators reported in the Clinical Journal of the American Society of Nephrology (2007;2:89-99). Pre-ESRD nephrology care was not associated with mortality risk in the subsequent 121-365 days.

Diagnosis of hypertension was associated with a 45% lower mortality risk during the first 120 days compared with the subsequent 121-365 days. During both periods, patients aged 75 and older were at higher mortality risk than those aged 45-64 years (reference); white patients were at higher risk compared with nonwhites.

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