演題情報

学会・委員会企画

開催回
第56回・2011年・横浜
 

Dialysis Initiation in Taiwan

演題番号 : GI-8-2

Shang-Jyh Hwang:1

1:Faculty of Medicine & Renal Care, College of Medicine, Kaohsiung Medical University, Kaohsiung, Taiwan

 

ESRD patients initiating maintenance dialysis is regulated by Bureau of National Health Insurance through review process. The absolute indications for dialysis are CKD plus either creatinine clearance less than 5 ml/min or serum Cr greater than 10 mg/dl; the relative indications are CKD plus either Ccr less than 15 ml/min or serum greater than 6.0 mg/dl in diabetics, and either Ccr less than 10 ml/min or serum Cr greater than 8 mg/dl in non-diabetics, but both must have fluid overload or uremic symptoms/signs. We studied eGFR and co-morbidity at dialysis initiation in relation to mortality, using a national database including 23,551 incident hemodialysis patients from July 2001 to December 2004. The median eGFR at dialysis initiation was low (4.7 ml/min/1.73m2) as was the mortality in the first year of dialysis (13.2/100 patient-year, 95% C.I.: 12.8-13.7). There was an inverse association between lower eGFR and higher survival rate. Cox regression model revealed increase in mortality risk in higher eGFR quantiles compared to the reference group after adjustement. Propensity score analysis also showed higher eGFR associated with increased mortality risks. Thus, conditions at dialysis initiation explained excess risk differently on one year mortality in patients who began dialysis at different levels of eGFR. However, there are still other factors contributing to the mortality of patients initiating dialysis at higher eGFR levels.Initiation of dialysis should not solely depend on a level of renal function, but would be better based on the individual patients comorbid condition under local regulations.

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