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Author Interview:
Maurizio Nordio, MD, MSc and Umberto Maggiore, MD, PhD

Nephrology and Dialysis Unit, ULSS 15, Camposampiero–Cittadella, Padua, Italy

Department of Clinical Medicine, Nephrology and Health Care, Parma University, Parma, Italy

Publication:

Survival in Patients Treated by Long-term Dialysis Compared With the General Population

Nordio M, Limido A, Maggiore U, Nichelatti M, Postorino M, Quintaliani G; Italian Dialysis and Transplantation Registry.

Nephrology and Dialysis Unit, ULSS 15, Camposampiero-Cittadella, Padua, Italy.
Am J Kidney Dis. 2012 Feb 21. [Epub ahead of print]

 

What are the main findings of the study?

Our study estimated how much survival is reduced by CKD on dialysis compared to general population and found that the 5-year survival of dialysis patients  is about  55% relative to the general population. Excess mortality estimates are statistical measures of the burden of chronic diseases, and allow the prognosis of end stage renal disease be compared with that of other chronic diseases, such as several kinds of cancers, heart failure, diabetes, thus ranking the severity of different chronic conditions .

Our study also found that, compared to the general population,  the excess mortality in dialysis patients is highest  in the first year after initiation of dialysis. This finding might imply that dialysis treatment does not modify prognosis of those patients who are going to die soon regardless of the administered treatment,  and that the commonly used dialysis techniques are not able to cure some patients.

On the other hand, in the long term, excess mortality remains roughly constant over time (up to ten years). Unlike the short-term excess mortality, the long-term excess mortality is directly linked to the end stage renal disease condition.

Were any of the findings unexpected?

We cannot really claim that our findings were unexpected.  Rather, we may say that our study confirms previous findings, but it expresses them in a more clear and informative way.  

We also knew already that mortality on long term dialysis is high and that early mortality is exceedingly high, but so far we were not able to quantify such findings and to provide a context to this feeling.

What should clinicians and patients take away from this study?

Both clinicians and patients have now at their disposal the information allowing the formulation of a reliable prognosis about the long term dialysis outcome.

A special attention must be paid to older subjects. In this category we see the highest mortality compared to the general population. In Europe, especially in UK and in Italy, there is a debate about conservative therapy (in particular very low protein diet) because it seems as effective as dialysis at least in patients with preserved diuresis.

This means that the nephrology community feels the inadequacy of the treatment provided. It remains to be totally explored the potentiality of peritoneal dialysis in this group of patients, since from our and others’ data it appears that this treatment modality has been reserved up to now to younger and relatively healthier subjects.

What recommendations do you have for future studies as a result of your study?

We think that the main recommendation should be made to Health Authorities, since CKD on dialysis is a more severe disease than many types of cancers, but, surely, it hasn’t received as much attention despite its important incidence in the elderlies within the general population.

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