Yonsei Med J.  2015 May;56(3):666-675. 10.3349/ymj.2015.56.3.666.

Improving Survival Rate of Korean Patients Initiating Dialysis

• Ryu JH
• Kim H
• Kim KH
• Hann HJ
• Ahn HS
• Lee S
• Kim SJ
• Kang DH
• Choi KB
• Ryu DR

• KMID: 2450339
• DOI: http://doi.org/10.3349/ymj.2015.56.3.666

Abstract

PURPOSE
The aim of this study was to investigate whether the survival rate among Korean dialysis patients changed during the period between 2005 and 2008 in Korea.
MATERIALS AND METHODS
A total of 32357 patients who began dialysis between January 1, 2005 and December 31, 2008 were eligible for analysis. Baseline demographics, comorbidities, and mortality data were obtained from the database of the Health Insurance Review & Assessment Service.
RESULTS
Kaplan-Meier curves according to the year of dialysis initiation showed that the survival rate was significantly different (log-rank test, p=0.005), most notably among peritoneal dialysis (PD) patients (p<0.001), although not among hemodialysis (HD) patients (p=0.497). In multivariate analysis, however, patients initiating either HD or PD in 2008 also had a significantly lower risk of mortality compared to those who began dialysis in 2005. Subgroup survival analysis among patients initiating dialysis in 2008 revealed that the survival rate of PD patients was significantly higher than that of HD patients (p=0.001), and the survival benefit of PD over HD remained in non-diabetic patients aged less than 65 years after adjustment of covariates.
CONCLUSION
Survival of Korean patients initiating dialysis from 2005 to 2008 has improved over time, particularly in PD patients. In addition, survival rates among patients initiating dialysis in 2008 were different according to patients' age and diabetes, thus we need to consider these factors when dialysis modality should be chosen.

Keyword

Survival; peritoneal dialysis; hemodialysis; Korea

MeSH Terms

Adult
Aged
Comorbidity
Female
Humans
Kaplan-Meier Estimate
Kidney Failure, Chronic/*mortality/therapy
Male
Middle Aged
Multivariate Analysis
Peritoneal Dialysis/*statistics & numerical data
Registries
Renal Dialysis/*statistics & numerical data
Republic of Korea/epidemiology
Risk
Survival Analysis
Survival Rate/*trends
Treatment Outcome

Figure

• 

  Fig. 1 Crude survival curves according to the dialysis initiation year and multivariate analysis of mortality of the entire patient cohort. (A) Survival rate differed significantly according to the year of dialysis initiation (log-rank test, p=0.005). (B) Multivariate Cox analysis revealed the following significant predictors of mortality: the year of dialysis initiation, age, sex, type of Healthcare Security System, dialysis modality, and modified CCI. MA, Medical Aid; NHI, National Health Insurance; PD, peritoneal dialysis; HD, hemodialysis; CCI, Charlson Comorbidity Index; HR, hazard ratio; CI, confidence interval.

• 

  Fig. 2 Crude survival curves in subgroup analysis stratified dialysis modality of all patients initiating dialysis. (A) In patients initiating PD, survival rate was significantly different according to the year of dialysis initiation (log-rank test, p<0.001). (B) However, in patients initiating HD, there was no significant difference in survival according to the year of dialysis initiation (p=0.497). PD, peritoneal dialysis; HD, hemodialysis.

• 

  Fig. 3 Multivariate analyses of mortality in subgroups according to dialysis modality, age categories, and diabetes. (A) After adjusting for age, sex, type of Healthcare Security System, and modified CCI, patients initiating either HD or PD in 2008 had significantly lower mortality. (B) After adjusting for age, sex, type of Healthcare Security System, dialysis modality, and modified CCI, the statistical significance of this difference was lost only among non-diabetic patients aged less than 65. PD, peritoneal dialysis; HD, hemodialysis; ND, non-diabetic; DM, diabetes mellitus; HR, hazard ratio; CI, confidence interval; CCI, Charlson Comorbidity Index.

• 

  Fig. 4 Crude survival curves and multivariate analysis for mortality of patients initiating dialysis in 2008. (A) Survival rate of PD patients was significantly higher than HD patients by log-rank test (p=0.001). (B) Multivariate Cox analysis revealed age, sex, type of Healthcare Security System, and modified CCI were all significant predictors for mortality, whereas dialysis modality was not a significant predictor. PD, peritoneal dialysis; HD, hemodialysis; MA, Medical Aid; NHI, National Health Insurance; CCI, Charlson Comorbidity Index; HR, hazard ratio; CI, confidence interval.

• 

  Fig. 5 Kaplan-Meier survival curves and comparisons of survival rates by log-rank test in subgroups stratified by age categories and the presence of diabetes. (A) In non-diabetic patients aged less than 65, the survival rate of PD patients was higher than that of HD patients (p<0.001). (B) In non-diabetic patients aged 65 or older, the survival rate was not significantly different between the two groups (p=0.377). (C) In diabetic patients aged less than 65, the survival rate of PD patients was similar to that of HD patients (p=0.974). (D) In diabetic patients aged 65 or older, the survival rate of HD patients was higher than that of PD patients (p=0.004). PD, peritoneal dialysis; HD, hemodialysis.

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