MORTALITY-RATES AMONG DIALYSIS PATIENTS IN MEDICARE END-STAGE RENAL-DISEASE PROGRAM

Medicare's End-Stage Renal Disease (ESRD) Program provides funding for life-saving renal replacement therapy for patients with irreversible chronic renal failure. Although more than 100,000 patients are currently alive due to dialysis and transplantation, mortality among ESRD patients is still much higher than in the general population. Gross mortality, calculated from aggregate statistics such as those available from the annual ESRD facility survey, is an extremely imprecise measure of mortality and can lead to misleading conclusions. Standard methods of survival calculation such as actuarial life-table analyses provide more accurate descriptions of variations and trends in mortality. The most important characteristic influencing mortality among ESRD patients on dialysis is the changing age and diagnostic distribution. The average age of dialysis patients has increased by over 5 years during the past decade. Patients whose renal failure is attributed to diabetic nephropathy currently account for 30% of all patients initiating renal replacement therapy each year and constitute the fastest growing group of ESRD patients. From 1982 to 1987, 1-year survival on dialysis was 72.7% for patients whose renal failure was attributed to diabetic nephropathy and 79.8% for all other patients. Survival decreases rapidly with advancing age at time of renal failure, from 95.1% among patients 15 to 24 years to 52.5% for patients over the age of 85 (for nondiabetics). Survival rates for whites are 5% to 6% lower than for other racial categories. There are no obvious trends in mortality among dialysis patients over the past decade. For patients whose renal failure is attributed to diabetic nephropathy, survival rates have remained constant despite overall aging in this group. For the remaining diagnostic groups, mortality has also remained constant except for a one time drop in survival between 1982 and 1983. Although there is no direct evidence of increased severity of disease among this category of patients, the extension of dialysis therapy to older patients is suggestive that additional unmeasured changes in severity may account for these mortality changes. The annual mortality rate due to voluntary withdrawal from dialysis is approximately 2.1%. This ranges from a low of 0.1% among the 15- to 24-year age group to 9.9% among the over 85 age group. © 1990, National Kidney Foundation, Inc.. All rights reserved.