演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Explaining International Differences in Survival on Dialysis: Results from the EVEREST Study

演題番号 : GI-7-1

Fergus J Caskey:1、Anneke Kramer:2、Vianda Stel:2、Kitty J Jager:2

1:School of Clinical Sciences, University of Bristol, Bristol, UK、2:The ERA-EDTA Registry, Amsterdam Medical Centre, Amsterdam, The Netherlands

 

【Background】 Survival on dialysis varies considerably worldwide. This analysis examines the independent association between general population health status, macroeconomics, healthcare system and renal service characteristics and survival on dialysis.  【Methods】 Kaplan Meier survival tables were provided by collaborating registries for patients commencing renal replacement therapy in 2003-2005 and alive at day 91; for registries routinely submitting data to the ERA-EDTA Registry survival tables were prepared with permission. Two-year survival on dialysis (censoring for transplant) was the primary outcome. General population age and health and macroeconomic indices were collected from secondary sources. Renal service organisation and resource data were obtained through interviews and questionnaires with national experts. Following log-log transformation of survival probabilities, linear regression models established the factors independently associated with survival; transformation of regression coefficients back to the original scale enable interpretation as hazard ratios. 【Results】 Of the 46 EVEREST countries, 22 provided survival data. Two-year survival ranged from 62.3% in Iceland to 89.8% in Romania, (median (IQR): 71.9% (66.2% - 75.3%)). GDP per capita, % GDP spent on healthcare, RRT incidence and the general population mortality were univariately associated with 2-year dialysis survival. GDP per capita (HR 1.023 per 1000USD, 95% CI 1.002-1.045), % GDP spent on healthcare (1.103 per %, 1.035-1.175) and general population mortality (1.038 per 1 death per 10 000 patient years, 1.009-1.069) proved independently associated with 2-year dialysis survival. 【Conclusions】 Macroeconomic factors and general population mortality were independently associated with survival on dialysis. Renal service organisational factors and RRT incidence appear less important.

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