Tsakiris D, Jones E H, Briggs J D, Elinder C G, Mehls O, Mendel S, Piccoli G, Rigden S P, Pintos dos Santos J, Simpson K, Vanrenterghem Y
Department of Nephrology, Veria General Hospital, Greece.
Nephrol Dial Transplant. 1999 Oct;14(10):2343-50. doi: 10.1093/ndt/14.10.2343.
Patients who die within 90 days of commencing renal replacement therapy (RRT) may be recorded by some centres and not others, and hence data on mortality and survival may not be comparable. However, it is essential to compare like with like when analysing differences between modalities, centres and registries. It was decided, therefore, to look at the incidence of deaths within 90 days in the ERA-EDTA Registry, and to try to define the characteristics of this group of patients.
Between 1 January 1990 and 31 December 1992, 78 534 new patients started RRT in 28 countries affiliated to the ERA-EDTA Registry. Their mean age was 54 years and 31% were over 65 years old. Eighty-two per cent of the patients received haemodialysis (HD), 16% peritoneal dialysis (PD) and 2% had preemptive transplantation as first mode of treatment.
From January 1990 to March 1993 the overall incidence of deaths was 19% and 4% of all patients died within 90 days from the start of RRT. Among those dying within 90 days 59% were over 65 years compared to 53% over 65 years in those dying beyond this time (P<0.0001). The modality of RRT did not influence the distribution of deaths before and after 90 days. Vascular causes and malignancy were more common in those dying after 90 days, while there were more cardiac and social causes among the early deaths. Mortality from social causes was twice as common in the elderly, who had a significantly higher chance of dying from social causes within 90 days compared to those aged under 65 years. The overall incidence of deaths within 90 days was 3.9% but there was a wide variation between countries, from 1.8% to 11.4%. Finally, patient survival at 2 years was markedly influenced in different age groups when deaths within 90 days were taken into account.
The incidence of deaths within 90 days from the start of RRT was 3.9%, with a marked variation between countries ranging from 1.8% to 11.4%, which probably reflects mainly differences in reporting these deaths, although variable selection criteria for RRT may contribute. Deaths within 90 days were significantly more frequent in elderly patients with more early deaths resulting from cardiac and social causes, while vascular causes of death and malignancy were more common in those dying after 90 days. Patient survival analyses should take into account deaths within 90 days from the start of RRT, particularly when comparing results between modalities, countries and registries.
开始肾脏替代治疗（RRT）后90天内死亡的患者，有些中心可能会记录，有些则不会，因此死亡率和生存率数据可能缺乏可比性。然而，在分析不同治疗方式、中心和登记处之间的差异时，必须进行同类比较。因此，决定观察欧洲肾脏协会-欧洲透析和移植协会（ERA-EDTA）登记处90天内的死亡发生率，并试图明确这组患者的特征。
1990年1月1日至1992年12月31日期间，ERA-EDTA登记处所属28个国家的78534例新患者开始接受RRT治疗。他们的平均年龄为54岁，31%的患者年龄超过65岁。82%的患者接受血液透析（HD），16%接受腹膜透析（PD），2%的患者以预先移植作为首次治疗方式。
1990年1月至1993年3月，总死亡率为19%，4%的患者在开始RRT后90天内死亡。在90天内死亡的患者中，59%的患者年龄超过65岁，而在90天后死亡的患者中这一比例为53%（P<0.0001）。RRT的治疗方式不影响90天前后死亡的分布情况。血管性病因和恶性肿瘤在90天后死亡的患者中更为常见，而早期死亡的患者中心脏和社会相关病因更多。社会相关病因导致的死亡率在老年人中是年轻人的两倍，65岁及以上老年人在90天内死于社会相关病因的可能性明显高于65岁以下人群。90天内的总死亡率为3.9%，但各国之间差异很大，从1.8%到11.4%不等。最后，考虑90天内死亡情况时，不同年龄组的患者2年生存率受到显著影响。
开始RRT后90天内的死亡率为3.9%，各国之间差异显著，从1.8%到11.4%不等，这可能主要反映了这些死亡病例报告方式的差异，尽管RRT的入选标准不同也可能有影响。90天内死亡在老年患者中更为常见，早期死亡更多由心脏和社会相关病因导致，而血管性死因和恶性肿瘤在90天后死亡的患者中更为常见。患者生存分析应考虑开始RRT后90天内的死亡情况，尤其是在比较不同治疗方式、国家和登记处的结果时。
