A multinational hemodialysis patient survival comparison.
ASN 30th Annual Meeting, San Antonio
J Am Soc Nephrol (Sep) 8:186A 1997
This prospective analysis of 761 patients from 13 dialysis centers in Japan, Australia, Sweden, and the US compared survival rates between the countries, and attempted to determine whether or not various treatment parameters could explain survival differences.
Using a proportional hazards model, age, serum albumin level, and body mass index were associated with survival, as expected. Kt/V measures were not associated with survival, perhaps because the mean Kt/V level in all countries was already high, averaging 1.3. Racial and ethnic factors remained highly predictive of survival, even after controlling for age, albumin, BMI, and Kt/V. For example, relative risk of US black patients vs. US white patients for mortality was 0.62. For patients dialyzed in Japan, Australia, and Sweden, relative risks for mortality after making the above adjustments were 0.3, 0.66, and 1.20, respectively.
Comment: Although patient age, duration of dialysis treatment, albumin levels, and body mass index are easy to compare, Kt/V (arguably a most critical determinant of dialysis patient outcome) is likely computed by widely differing methodologies in each of the countries studied. This point weakens the conclusion that differences in these parameters are not important determinants of survival differences. The study illustrates the need to identify accurate measures by which to compare outcomes between countries with differing demographic, clinical , and geopolitical (health care policy) climates. (Rick L. Latos, M.D., Wheeling, WV)
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ASN 30th Annual Meeting, San Antonio
CRF: Problem Areas : Outcomes (Morbidity, Mortality)