Progress in reducing mortality is a core measure of success for dialysis providers. First-year mortality among patients in freestanding dialysis facilities has declined in successive incident cohorts since 2004. As with incidence and hospitalization, there is stark regional variation in early mortality rates, with a range from 32 deaths per 100 patient years in the East North Central Census Division to only 21 deaths in the Mountain Division. Moreover, while nearly all Census Divisions have achieved cumulative declines in first-year mortality of 11–20 percent from 2004 to 2011, one area, the East Central North Division, has made no progress. Likewise, within Divisions, some states have achieved large declines in first-year mortality, while in other states rates have tended to increase in recent years. In the future, to focus provider efforts on improving early outcomes, these disparities must be addressed by the integration of morbidity and mortality data with data regarding pre-dialysis care, initial vascular access technique, and the use of oral medications.
We subsequently present data regarding weekly and daily mortality rates during the first year of treatment in patients who initiated dialysis in freestanding facilities in either 2004 or 2011. Mortality rates are highly elevated immediately after initiation of outpatient dialysis, and only gradually decline during the first 26 weeks. Interestingly, very high early mortality risk is apparent not only in elderly and very elderly patients, but also in much younger patients. The juxtaposition of data from 2004 and 2011 nevertheless demonstrates clear progress in reducing mortality risk during the first year, with particularly large gains during the second and third months. Improvements in early mortality translate as well to longer expected remaining lifetimes for incident dialysis patients, which we describe here. Between cohorts of incident patients in 2004 and 2010, patients between the ages of 20 and 34 years achieved gains in life expectancy exceeding two years. Gains in older age brackets were smaller in magnitude, but still evident.