Association of Comorbid Conditions and Mortality in Hemodialysis Patients in Europe, Japan, and the United States: The Dialysis Outcomes and Practice Patterns Study (DOPPS)
David A. Goodkin,Jennifer L. Bragg-Gresham,Karl G. Koenig,Robert A. Wolfe,Takashi Akiba,Vittorio E. Andreucci,Akira Saito,Hugh C. Rayner,Kiyoshi Kurokawa,Friedrich K. Port,Philip J. Held,Eric W. Young +11 more
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TLDR
Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US.Abstract:
Mortality rates among hemodialysis patients vary greatly across regions. Representative databases containing extensive profiles of patient characteristics and outcomes are lacking. The Dialysis Outcomes and Practice Patterns Study (DOPPS) is a prospective, observational study of representative samples of hemodialysis patients in France, Germany, Italy, Japan, Spain, the United Kingdom, and the United States (US) that captures extensive data relating to patient characteristics, prescriptions, laboratory values, practice patterns, and outcomes. This report describes the case-mix features and mortality among 16,720 patients followed up to 5 yr. The crude 1-yr mortality rates were 6.6% in Japan, 15.6% in Europe, and 21.7% in the US. After adjusting for age, gender, race, and 25 comorbid conditions, the relative risk (RR) of mortality was 2.84 (P < 0.0001) for Europe compared with Japan (reference group) and was 3.78 (P < 0.0001) for the US compared with Japan. The adjusted RR of mortality for the US versus Europe was 1.33 (P < 0.0001). For most comorbid diseases, prevalence was highest in the US, where the mean age (60.5 +/- 15.5 yr) was also highest. Older age and comorbidities were associated with increased risk of death (except for hypertension, which carried a multivariate RR of mortality of 0.74 [P < 0.0001]). Variability in demographic and comorbid conditions (as identified by dialysis facilities) explains only part of the differences in mortality between dialysis centers, both for comparisons made across continents and within the US. Adjustments for the observed variability will allow study of association between practice patterns and outcomes.read more
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TL;DR: The strikingly elevated mortality risk with lowpredialysis systolic BP suggests that low predialysis BP needs to be viewed with great concern and avoided where possible, and greater attention to postdialysis hypertension is suggested.
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The Dialysis Outcomes and Practice Patterns Study (DOPPS): An international hemodialysis study
Eric W. Young,Eric W. Young,David A. Goodkin,David A. Goodkin,Donna Mapes,Donna Mapes,Friedrich K. Port,Friedrich K. Port,Marcia L. Keen,Marcia L. Keen,Kenneth Chen,Kenneth Chen,Bradley L. Maroni,Bradley L. Maroni,Robert A. Wolfe,Robert A. Wolfe,Philip J. Held,Philip J. Held +17 more
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Journal ArticleDOI
Five-Year Survival for End-Stage Renal Disease Patients in the United States, Europe, and Japan, 1982 to 1987
Philip J. Held,Felix P. Brunner,Michio Odaka,Jose R. Garcia,Friedrich K. Port,Daniel S. Gaylin +5 more
TL;DR: Analysis of 5-year survival for new end-stage renal disease patients accepted for renal replacement therapy between 1982 and 1987 in the United States, Europe, and Japan showed that the US patients were older and more likely to be diabetic than the patients in either EDTA or Japan.
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