Dialysis survival in a large inner-city facility: a comparison to national rates.

Journal of the American Society of Nephrology : JASN
J C StivelmanE J Macon

Abstract

Impoverished patients may represent a high-risk population with poor survival. With 1993 U.S. Renal Data System survival tables (to adjust the risk of death for differences in age, race, and ESRD diagnosis), the mortality rates of patients over 3 yr in a large inner-city dialysis facility using high-flux technique were compared with national averages. At least 93.7% of patients were African-American, 50% had incomes below $7,000 per year, and employment was 5% or less. Observed and expected deaths (the latter derived from the U.S. Renal Data System tables) were used to calculate a standardized mortality ratio (observed deaths/expected deaths); the U.S. average is 1.0. The standardized mortality ratio at this facility for each year was < 0.600 and was significantly lower than the U.S. average in 1991, in 1992 (P < 0.05), and for all 3 yr (P < .001). Over all 3 yr, it was lower for females (0.540, P < 0.05), males (0.620, P < 0.05), patients with diabetes (0.593, P < 0.05), and glomerulonephritis (0.318, P < 0.05). For the 3 yr, a Cox regression analysis revealed independent associations between mortality and age (P = 0.004), serum albumin (P = 0.02), Kt/V (P = 0.02), and dialysis for more than 2 yr (P = 0.01). Patients with econ...Continue Reading

Citations

May 15, 1998·The New England Journal of Medicine·S Pastan, J Bailey
Oct 10, 1998·The New England Journal of Medicine·A K Singh
Nov 17, 2006·Journal of the American Society of Nephrology : JASN·Maki YoshinoNathan W Levin
Mar 23, 1999·The Urologic Clinics of North America·G E Amiel, A Atala
Dec 15, 2010·Health Services Research·Yi ZhangMae Thamer

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