1. Generalitat de Catalunya Departament de Salut MORTALITY RISK FACTORS FOR THE FIRST YEAR OF HAEMODIALYSIS IN CATALONIA 1997-2002 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

2. 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 (1997-2002) USRDS-(2001) Australia (ANZDATA)- (2002) UK- (1997-2001) RMRC (1997-2002) 051015202530 mortality per 100 patients/year HD DM

3. Generalitat de Catalunya Departament de Salut Causes of death. New cases 1997-2002 on HD

4. 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 1997-2002.

5. 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.

6. Generalitat de Catalunya Departament de Salut Methods (2) Patients: All patients older than 14 who initiated HD in Catalonia on the 1997-2002 period (n=4,704). Information about all variables was available for 4,579 (97.3% of all patients)

7. 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

8. 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.

9. Generalitat de Catalunya Departament de Salut Mortality rates and Standard Mortaliy Index (SMI) on the first year of HD after age group 20-2425-3435-4445-5455-6465-7475-84>84GLOBAL Age group 0 50 100 150 200 250 300 350 400 Rates per 1,000 Catalonia 2000HD 97-02 Referred to the Catalan Population 2000. 20-2425-3435-4445-5455-6465-7475-84>84GLOBAL Age group 0 20 40 60 80 100 SMI IC 95%IME.........

10. Generalitat de Catalunya Departament de Salut Causes of Death after Age Group. 20-2425-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84>84 Age at HD start 0 2 4 6 8 10 12 14 Mortality per 100 patients / year CardiovascularInfectionCancer

11. 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...

12. 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.....

13. 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..

14. 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..

15. 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.

16. 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...... <2525-2930-3435-3940-4445-4950-5455-5960-6465-6970-7475-7980-84>84 Age at start of HD 0 5 10 15 20 25 30 Percentage DiabetesSystemic dis.

17. 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..

18. 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..

19. Generalitat de Catalunya Departament de Salut Functional Autonomy Degree at HD start after Age Group and adjusted (*) Odds Ratio.. LimitedSpecial careLimitedSpecial careLimitedSpecial care 0,1 1 10 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.

20. 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.

21. 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)- 0.179- 0.160- 0.082 Age 0.360 0.288 0.306 PRD: diabetes 0.179 0.260 0.244 systemic 0.654 0.600 0.671 Funct. autonomy degree: limited 0.758 0.808 0.612 special care 1.285 1.209 1.227 Ischaemic heart dis. 0.108 0.231 0.366 Cardiomyopathy 0.329 0.288 0.203 Arrythmia 0.441 0.380 0.371 OCPD 0.261 0.267 0.345 Malignancies 0.454 0.311 0.631 Chronic liver disease 0.203 0.351 0.377 CRF Presentation: unknown 0.351 0.480 0.334 descompensation 0.088 0.121 0.071 Catheter 0.090 0.863 0.759 β 0 - 7,266- 5.880- 5.167

22. 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.

23. 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.