Is there a rationale for rationing chronic dialysis ? A hospital based cohort study of factors affecting survival and morbidity.
Objectives To determine factors influencing survival and need for hospitalisation in patients needing dialysis, and to define the potential basis for rationing access to renal replacement therapy.
Design Hospital based cohort study of all patients starting dialysis over a 4 year recruitment period (follow up 15-63 months).
Groups were defined on the basis of age, comorbidity, functional status, and whether dialysis initiation was planned or unplanned.
Setting Renal unit in a district general hospital, which acts as the main renal referral centre for four other such hospitals and serves a population of about 1.15 million people.
Subjects 292 patients, mean age 61.3 years (18-92 years, SD 15.8), of whom 193 (66%) were male, and 59 (20%) were patients with diabetes, Dialysis initiation was planned in 163 (56%) patients and unplanned in 129 (44%). Main outcome measures Overall survival, 1 year survival, and hospitalisation rate.
Results Factors affecting survival in the Cox's proportional hazard model were Karnofsky performance score at presentation (hazard ratio 0.979,95% confidence interval 0.972 to 0.986), comorbidity severity score (1.240,1.131 to 1.340), age (1.036,1.018 to 1.054), and myeloma (2.15,1.140 to 4.042).
The Karnofsky performance score used 3 months before presentation was significant (0.970,0.956 to 0.981), as was unplanned presentation in this model (1.796,1.233 to 2.617). (...)
Mots-clés Pascal : Hémodialyse, Chronique, Facteur risque, Arbre décision, Etude cohorte, Survie, Morbidité, Analyse coût efficacité, Analyse multivariable, Guide pratique, Analyse statistique, Homme, Epuration extrarénale, Economie santé
Mots-clés Pascal anglais : Hemodialysis, Chronic, Risk factor, Decision tree, Cohort study, Survival, Morbidity, Cost efficiency analysis, Multivariate analysis, Handbook, Statistical analysis, Human, Extrarenal dialysis, Health economy
Notice produite par :
Inist-CNRS - Institut de l'Information Scientifique et Technique
Cote : 99-0109162
Code Inist : 002B26G. Création : 16/11/1999.