Generalitat de Catalunya Departament de Salut MORTALITY RISK FACTORS FOR THE FIRST YEAR OF HAEMODIALYSIS IN CATALONIA J. M. Mauri 1, M. Clèries 2, E. Vela 2 and RMRC 2. 1 Hospital Universitari de Girona “Dr Josep Trueta”, 2 Registre de Malalts Renals de Catalunya. OCATT, Servei Català de la Salut Sociedad Española de Nefrologia Málaga. Octubre, 2005

Generalitat de Catalunya Departament de Salut Mortality indicators: international comparison (2) 21,1 13,6 14,25 16,2 25,1 17,7 18,5 21,3 USRDS-(2001) Australia (ANZDATA)- (2002) Italy (Soc. Nefrol)-(2002) RMRC ( ) USRDS-(2001) Australia (ANZDATA)- (2002) UK- ( ) RMRC ( ) mortality per 100 patients/year HD DM

Generalitat de Catalunya Departament de Salut Causes of death. New cases on HD

Generalitat de Catalunya Departament de Salut Objective To analyze the risk factors related to early mortality (90 days), and the mortality at 6 months and in the first year after starting haemodialysis, on the patients entered in the period

Generalitat de Catalunya Departament de Salut Methods (1) Data Source: Catalan Renal Registry (RMRC).Health Department of the Government of Catalonia The RMRC was created in 1984 Declaration is obligated for all patients admitted on RRT in Catalonia On time up-date for changing modality of RRT and mortality, and Annual up-date for morbidity, mortality, vascular access and the usual those clinical and biological parameters.

Generalitat de Catalunya Departament de Salut Methods (2) Patients: All patients older than 14 who initiated HD in Catalonia on the period (n=4,704). Information about all variables was available for 4,579 (97.3% of all patients)

Generalitat de Catalunya Departament de Salut Methods (3) Risk Factors studied: AgeSex Primary renal diseaseCardiac diseases StrokeArrythmia Peripheral vascular diseasesMalignancies Liver Chronic diesasesOPD TuberculosisInfection Arthropaty Gut diseases Esoph., stomach& duod. Presentation of ESRD 1st Vascular access Functional autonomy degree

Generalitat de Catalunya Departament de Salut Methods (4) Statistics:  2 for comparison of proportions. Logistic Regression to identify the risk factors associated to early death (90 days, 6 moths & 1 year). Signification was adjusted for p<0.05. An examination of all possible two-way interactions are tested. Calibration was assessed using Hosmer-Lemeshow goodness-of-fit test and discrimination using the area under the receiver operating characteristics (ROC) curve.

Generalitat de Catalunya Departament de Salut Mortality rates and Standard Mortaliy Index (SMI) on the first year of HD after age group >84GLOBAL Age group Rates per 1,000 Catalonia 2000HD Referred to the Catalan Population >84GLOBAL Age group SMI IC 95%IME

Generalitat de Catalunya Departament de Salut Causes of Death after Age Group >84 Age at HD start Mortality per 100 patients / year CardiovascularInfectionCancer

Generalitat de Catalunya Departament de Salut Adjusted (*) Odds Ratios for Age (10 years). OR at 90 daysOR at 6th monthsOR at 1 year 0,2 2...

Generalitat de Catalunya Departament de Salut CRF Presentation at HD start after Age Group and adjusted (*) Odds Ratio (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.. Unknown Descompensation Unknown Descompensation Unknown Descompensation 0,2 2 OR at 90 daysOR at 1st yearOR at 6 months.....

Generalitat de Catalunya Departament de Salut OCPD at HD start after Age Group and adjusted (*) Odds Ratio (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2..

Generalitat de Catalunya Departament de Salut Malignancies at HD start after Age Group and adjusted (*) Odds Ratio (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2..

Generalitat de Catalunya Departament de Salut Chronic liver dis. at HD start after Age Group and adjusted (*) Odds Ratio. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2.. (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.

Generalitat de Catalunya Departament de Salut PRD at HD Start after Age Group and adjusted (*) Odds Ratios.. DNSystemic D.DNSystemic D.DNSystemic D. 0, 2 2 OR at 90 DaysOR at 1 YearOR at 6 Months (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access < >84 Age at start of HD Percentage DiabetesSystemic dis.

Generalitat de Catalunya Departament de Salut Ischaemic Cardiopathy at the HD start after age group, and adjusted (*) Odds Ratios. (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2..

Generalitat de Catalunya Departament de Salut Arrythmia at HD start after Age Group and adjusted (*) Odds Ratio (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2..

Generalitat de Catalunya Departament de Salut Functional Autonomy Degree at HD start after Age Group and adjusted (*) Odds Ratio.. LimitedSpecial careLimitedSpecial careLimitedSpecial care 0, OR at 90 daysOR at 1st yearOR at 6 months.... (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.

Generalitat de Catalunya Departament de Salut Catheter as a first VA at HD start after Age group and adjusted (*) Odds Ratio. OR at 90 daysOR at 6th monthOR at 1st year 0,2 2.. (*)Adjusted for Age, Gender, Functional Autonomy Degree, Associate Morbidities, CRF Presentation and first choice Vascular Access.

Generalitat de Catalunya Departament de Salut Predictive models at 90 days, 6 months and 1 year Mathematical Model: π(x)= e βo+β1x 1+ e βo+β1x β: 90 days6 months1st year Sex (female) Age PRD: diabetes systemic Funct. autonomy degree: limited special care Ischaemic heart dis Cardiomyopathy Arrythmia OCPD Malignancies Chronic liver disease CRF Presentation: unknown descompensation Catheter β 0 - 7,

Generalitat de Catalunya Departament de Salut Exemples Man, 69 with Standard PRD, Descompensated CRF and limited FAD, and with Ischaemic heart disease. Man, 49 with Standard PRD, normal FAD, normal CRF Presentation and with associated Ischaemic heart disease.

Generalitat de Catalunya Departament de Salut Conclusions  Early mortality correlated with age, systemic PRD, arrythmia and OCPD  A strong correlation was found for patients starting HD with cardiovascular disease, catheter as first vascular access or suffering from a low functional autonomic level.  At six months Diabetes (both as PRD or co-morbidity) and late referral were found significant.  At one year, diabetes (both as PRD or comorbidity), ischaemic heart disease, arythmia and malignances attained signification.  A model-based predictive model may be suggested.  Further analysis are required to validate the model and to identify the correspondence degrees between either individual or associate morbid conditions as seen at the HD start and the cause of the death.