Association of comorbid conditions and mortality in hemodialysis patients in Europe, Japan, and the United States: The dialysis outcomes and practice patterns study (DOPPS)

被引:597
作者
Goodkin, DA
Bragg-Gresham, JL
Koenig, KG
Wolfe, RA
Akiba, T
Andreucci, VE
Saito, A
Rayner, HC
Kurokawa, K
Port, FK
Held, PJ
Young, EW
机构
[1] Univ Michigan, Div Nephrol, Ann Arbor, MI 48109 USA
[2] Dept Vet Affairs Med Ctr, Ann Arbor, MI USA
[3] Birmingham Heartlands Hosp, Birmingham B9 5ST, W Midlands, England
[4] Tokai Univ, Kanagawa 2591100, Japan
[5] Univ Naples Federico II, Naples, Italy
[6] Tokyo Womens Med Univ, Tokyo, Japan
[7] Univ Michigan, Sch Publ Hlth, Dept Biostat, Ann Arbor, MI 48109 USA
[8] Univ Michigan, Kidney Epidemiol & Cost Ctr, Ann Arbor, MI 48109 USA
[9] Univ Renal Res & Educ Assoc, Ann Arbor, MI 48103 USA
[10] Amgen Inc, Thousand Oaks, CA 91320 USA
来源
JOURNAL OF THE AMERICAN SOCIETY OF NEPHROLOGY | 2003年 / 14卷 / 12期
关键词
D O I
10.1097/01.ASN.0000100127.54107.57
中图分类号
R5 [内科学]; R69 [泌尿科学(泌尿生殖系疾病)];
学科分类号
1002 ; 100201 ;
摘要
Mortality rates among hemodialysis patients vary greatly across regions. Representative databases containing extensive profiles of patient characteristics and outcomes are lacking. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States (US) that captures extensive data relating to patient characteristics, prescriptions, laboratory values, practice patterns, and outcomes. This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr. The crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. After adjusting for age, gender, race, and 25 comorbid conditions, the relative risk (RR) of mortality was 2.84 (P < 0.0001) for Europe compared with Japan (reference group) and was 3.78 (P < 0.0001) for the US compared with Japan. The adjusted RR of mortality for the US versus Europe was 133 (P < 0.0001). For most comorbid diseases, prevalence was highest in the US, where the mean age (60.5 +/- 15.5 yr) was also highest. Older age and comorbidities were associated with increased risk of death (except for hypertension, which carried a multivariate RR of mortality of 0.74 [P < 0.0001]). Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US. Adjustments for the observed variability will allow study of association between practice patterns and outcomes.
引用
收藏
页码:3270 / 3277
页数:8
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