Weekly mortality rates, as estimated from the date of the first dialysis session in a freestanding facility (a departure in methodology from that of the United States Renal Data System) and mathematically smoothed, declined between annual cohorts of incident patients in 2004 and 2011, with relatively larger improvements between weeks four and 12. Among incident patients in 2011, the rate of death was highest immediately, declined thereafter, and reached a steady state by week 28. Patterns are similar within strata defined by age, but with absolutely higher mortality rates associating with older age at dialysis initiation.
Impressively, among elderly patients initiating dialysis in 2011, mortality rates declined immediately after the first week, rather than remaining elevated for several weeks before declining more sharply, as rates did among incident patients in 2004.
Sudden cardiac death is the most frequently listed cause of death in dialysis patients, so attention should be focused on ultrafiltration, dialysate composition, and arrhythmias possibly induced by medication. Because incident patients often have residual renal function, however, decisions about ultrafiltration and dialysate composition must be carefully considered.
WEEKLY MORTALITY RATES IN INCIDENT DIALYSIS PATIENTS
WEEKLY MORTALITY RATES IN INCIDENT DIALYSIS PATIENTS, BY AGE
Daily Mortality Rates in Incident Dialysis Patients
Daily mortality rates during the first 180 days after initiating dialysis in a freestanding facility are highly volatile, partially because these rates mix the influence of time since dialysis initiation with seasonality in mortality rates. Apart from smoothed trends in the rates, it is noteworthy that daily rates actually tend to increase during the first 14 days of dialysis. Possible causes of this escalation in risk should be explored. Within strata defined by age, there are large improvements in early mortality among incident patients age 65–79. Future reports should probe the timing of death with respect to days on or off dialysis, to occurrence before or after the dialysis session (in the case of death on days on dialysis), and to the day immediately after the interdialytic interval.