Key result
Commencement of maintenance hemodialysis in adults with ESRD is associated with an early mortality rate of 32.6 per 100 person-years (95% CI 32.4-32.8), or 16.3% in the first 180 days.
Why the study?
Mortality rates are reported to be high soon after the commencement of maintenance HD for ESRD, prompting an estimation of early mortality rates within 180 days of starting therapy.
What is the early mortality rate in adults commencing maintenance hemodialysis for ESRD?
Meta-Analysis (n=1,083,264)
Yes
What is the early mortality rate in adults commencing maintenance hemodialysis for ESRD?
Effect estimate: SMR 8.8 (95% CI 32.4-32.8)
Patients starting maintenance hemodialysis face a very high early mortality rate of 16.3% in the first 180 days, which is 8.8 times higher than the general population, largely driven by cardiovascular causes.
Calls for intensified early monitoring and CV risk mitigation in new HD patients; confirms substantial early mortality burden from pooled data.
Mortality rates are reported to be high soon after the commencement of maintenance HD for ESRD. Our aim was to estimate early mortality rates (deaths within 180 days of starting therapy), through a systematic review of literature, in this patient population. Medline and EMBASE were searched for publications between 1 January 1985 and 31 December 2017. Observational studies reporting deaths involving adults commencing HD were included. The Quality in Prognosis Studies tool was used to assess risk of bias in studies. Crude mortality rates (expressed in 100 person-years) and age-standardized mortality ratios (SMR) were calculated. Meta-analyses of these rates were conducted for studies with lowest risk of bias (i.e. highest quality). In total, 32 studies were included (combined population: 1 083 264) representing 283 277 person-years of observation; median follow-up: 90 days. Mortality rates ranged between 12.8 and 55.6 per 100 person-years. Cardiovascular causes accounted for the majority of early deaths. Meta-analysis of high-quality studies showed an overall crude mortality rate of 32.6 per 100 person-years (95% CI 32.4-32.8). This equates to 16.3% mortality in first 180 days of starting HD. Six high-quality studies contained sufficient data for calculation of SMR. Meta-analysis of SMRs showed that patients starting HD therapy sustain 8.8 times higher mortality rates compared to the general population. We have combined the results of high-quality studies to produce new estimates of early mortality rates after commencement of HD therapy. This information can help relay more reliable prognostic information to this patient population.
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Hazara et al. (2019) conducted a meta-analysis in End-Stage Renal Disease (ESRD) (n=1,083,264). Maintenance hemodialysis vs. General population was evaluated on Early mortality (deaths within 180 days of starting therapy) (SMR 8.8, 95% CI 32.4-32.8). Commencement of maintenance hemodialysis in adults with ESRD is associated with an early mortality rate of 32.6 per 100 person-years (95% CI 32.4-32.8), or 16.3% in the first 180 days.
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