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Effect of Age, Gender, and Diabetes on Excess Death in End-Stage Renal Failure

Emmanuel Villar^*,,, Laurent Remontet^,, Michel Labeeuw^*,, René Ecochard^, on behalf of the Association Régionale des Néphrologues de Rhône–Alpes and the French Renal Epidemiology and Information Network (REIN) Registry

^* Department of Nephrology, Dialysis and Transplantation, Lyon Sud Hospital, Pierre-Bénite, and Service of Biostatistics, Hospices Civils de Lyon, UMR CNRS 5558, and Claude Bernard University, Lyon, France

Correspondence: Dr. Emmanuel Villar, Service de Néphrologie, Dialyse et Transplantation, Centre Hospitalier Lyon Sud, 165, chemin du Grand Revoyet, 69495 Pierre Bénite Cedex, France. Phone: +33-4-72-67-87-14; Fax: +33-4-72-67-87-10; E-mail: emmanuel.villar{at}chu-lyon.fr

Received for publication September 25, 2006. Accepted for publication April 23, 2007.

Life expectancy is short in elderly individuals with end-stage renal failure (ESRF). This study aimed to compare mortality in patients with ESRF versus the general population (GP) to assess the evolution of excess mortality by age, gender, nephropathy, and dialysis modality after first dialysis. All incident adult dialysis patients from January 1,1999, to December 31, 2003, who lived in Rhône–Alpes Region (France) were included and followed up to death or December 31, 2005. Standardized mortality ratios (SMR) in comparison with GP were computed in the first to the fifth years after first dialysis. In the whole cohort (3025 incident patients), SMR decreased during these 5 yr from 7.4 to 5.2 (P = 0.002). In the 18- to 44-, 45- to 64-, 65- to 74-, 75- to 84-, and 85-yr-old groups, SMR decreased from 26.7 to 6.2 (P = 0.01), from 12.8 to 8.1 (P = 0.03), from 8.6 to 5.6 (P = 0.051), from 7.1 to 4.5 (P = 0.02), and from 3.5 to 1.2 (P = 0.14), respectively. Among age categories, differences were significant in the first 3 yr (P < 0.05). SMR were higher 1.5-fold in women than in men in the first 4 yr (P < 0.05). In patients with diabetic nephropathy (DN), SMR increased during the first 3 yr (P = 0.045) and were higher than in patients without DN in the second, third, and fourth years (P < 0.05). SMR were higher in the peritoneal dialysis than in the hemodialysis group in the fourth year (P < 0.01). Patients with ESRF have a high excess mortality compared with the GP. Older patients with ESRF experienced less excess mortality. ESRF cancels out women's survival advantage noted in the GP. SMR evolution in patients with DN was different from that in patients without DN.

This article has been cited by other articles:

				E. Villar and M. Labeeuw Relative mortality risk in chronic kidney disease and end-stage renal disease: the effect of age, sex and diabetes Nephrol. Dial. Transplant., May 1, 2008; 23(5): 1770 - 1771. [Full Text] [PDF]

				E. Villar, S. H. Chang, and S. P. McDonald Incidences, Treatments, Outcomes, and Sex Effect on Survival in Patients With End-Stage Renal Disease by Diabetes Status in Australia and New Zealand (1991 2005) Diabetes Care, December 1, 2007; 30(12): 3070 - 3076. [Abstract] [Full Text] [PDF]

Copyright © 2008 by the American Society of Nephrology. Online ISSN: 1533-3450 Print ISSN: 1046-6673