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Clin J Am Soc Nephrol. 2012 Oct;7(10):1655-63. doi: 10.2215/CJN.10461011. Epub 2012 Jul 26.

Exploring the association between macroeconomic indicators and dialysis mortality.

Author information

1
European Renal Association-European Dialysis and TransplantationAssociation Registry, Academic Medical Center, University of Amsterdam, The Netherlands. a.kramer@amc.uva.nl

Abstract

BACKGROUND AND OBJECTIVES:

Mortality on dialysis varies greatly worldwide, with patient-level factors explaining only a small part of this variation. The aim of this study was to examine the association of national-level macroeconomic indicators with the mortality of incident dialysis populations and explore potential explanations through renal service indicators, incidence of dialysis, and characteristics of the dialysis population.

DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS:

Aggregated unadjusted survival probabilities were obtained from 22 renal registries worldwide for patients starting dialysis in 2003-2005. General population age and health, macroeconomic indices, and renal service organization data were collected from secondary sources and questionnaires. Linear modeling with log-log transformation of the outcome variable was applied to establish factors associated with survival on dialysis.

RESULTS:

Two-year survival on dialysis ranged from 62.3% in Iceland to 89.8% in Romania. A higher gross domestic product per capita (hazard ratio=1.02 per 1000 US dollar increase), a higher percentage of gross domestic product spent on healthcare (1.10 per percent increase), and a higher intrinsic mortality of the dialysis population (i.e., general population-derived mortality risk of the dialysis population in that country standardized for age and sex; hazard ratio=1.04 per death per 10,000 person years) were associated with a higher mortality of the dialysis population. The incidence of dialysis and renal service indicators were not associated with mortality on dialysis.

CONCLUSIONS:

Macroeconomic factors and the intrinsic mortality of the dialysis population are associated with international differences in the mortality on dialysis. Renal service organizational factors and incidence of dialysis seem less important.

PMID:
22837275
PMCID:
PMC3463213
DOI:
10.2215/CJN.10461011
[Indexed for MEDLINE]
Free PMC Article

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