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1-year mortality rate in older adults starting dialysis higher than previously thought

A recent study of 1-year mortality rates following dialysis initiation in adults over 65.5 years found that the mortality rate in older adults was nearly double the rate reported by the United States Renal Data System.

The study sought to address the knowledge gap in the United States Renal Data System (USRDS) registry, which does not include all patients who start dialysis as it omits those who die before they are entered in the registry by an outpatient dialysis provider, according to the researchers. The omissions meant that mortality estimates based on USRDS data are not applicable to all patients initiating dialysis.

To address the gap in the USRDS, researchers used data from the Health and Retirement Study to examine mortality in older adults within a year after initiating dialysis. Data from Apr. 3, 1998, to Dec. 21, 2014, linked to Medicare claims and the National Death Index, were used to identify all patients aged 65.5 years or older with fee-for-service Medicare and an initial claim for dialysis. Mortality was calculated at 30 days, 180 days and 365 days following dialysis initiation and 1-year Kaplan-Meier survival curves were created by age, comorbidity, pre-dialysis functional status and dialysis initiation setting.

Researchers found that among 391 Medicare beneficiaries initiating dialysis, death occurred within 30 days in 88 (22.5%) patients, 180 days in 173 (44.2%) patients and 365 days in 213 (54.5%) patients.

Risk factors associated with a higher risk of mortality within 1 year after initiating dialysis include activity of daily living dependence (HR = 1.88; 95% CI, 1.36-2.61), age older than 85 years (HR = 1.85; 95% CI, 1.23-2.8), inpatient dialysis initiation (HR = 2.17; 95% CI, 1.49-3.15) and having at least four comorbidities (HR = 1.5; 95% CI, 1.07-2.09).

The 1-year mortality rate in older adults initiating dialysis determined by researchers, 54.5%, was nearly double the approximately 30% 1-year mortality rate reported by the USRDS.

“The limited survival among older patients who initiated dialysis may help to frame prognostic expectations and support more informative discussions about dialysis initiation in older adults,” Melissa W. Wachterman, MD, MSc, MPH, of the section of general internal medicine at the Veteran Affairs Boston Health Care System, and colleagues wrote. – by Erin Michael

Disclosures: Wachterman reports no relevant financial disclosures.