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Chapter 3: Death and Survival on Dialysis. Wong Hin Seng Ong Loke Meng. Source: 21 st MDTR Report 2013, NRR. Table 3.1.1: Deaths on dialysis 2004-2013. Source: 21 st MDTR Report 2013, NRR. Figure 3.1.1: Death rates on dialysis 2004-2013. Annual death rate on PD. Annual death rate on HD.

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chapter 3 death and survival on dialysis

Chapter 3:Death and Survival on Dialysis

Wong Hin Seng

Ong Loke Meng

Source: 21st MDTR Report 2013, NRR

table 3 1 1 deaths on dialysis 2004 2013
Table 3.1.1: Deaths on dialysis 2004-2013

Source: 21st MDTR Report 2013, NRR

figure 3 1 1 death rates on dialysis 2004 2013
Figure 3.1.1: Death rates on dialysis 2004-2013

Annual death rate on PD

Annual death rate on HD

20

15

Death rate

10

5

0

'04

'05

'06

'07

'08

'09

'10

'11

'12

Year

Source: 21st MDTR Report 2013, NRR

table 3 1 2 causes of death on dialysis 2004 2013
Table 3.1.2: Causes of death on dialysis 2004-2013

Source: 21st MDTR Report 2013, NRR

table 3 2 1 a patient survival by dialysis modality analysis censored for change of modality
Table 3.2.1(a): Patient survival by dialysis modality analysis (censored for change of modality)

Source: 21st MDTR Report 2013, NRR

figure 3 2 1 a patient survival by dialysis modality analysis censored for change of modality
Figure 3.2.1(a): Patient survival by dialysis modality analysis (censored for change of modality)

Kaplan-Meier survival estimates, by Modality

1.00

0.75

Cumulative survival

0.50

HD

0.25

PD

0.00

0

12

24

36

48

60

72

84

96

108

120

Duration in months

Source: 21st MDTR Report 2013, NRR

table 3 2 1 b patient survival by dialysis modality analysis not censored for change of modality
Table 3.2.1(b): Patient survival by dialysis modality analysis (not censored for change of modality)

Source: 21st MDTR Report 2013, NRR

figure 3 2 1 b patient survival by dialysis modality analysis not censored for change of modality
Figure 3.2.1(b): Patient survival by dialysis modality analysis (not censored for change of modality)

Kaplan-Meier survival estimates, by Modality

1.00

0.75

Cumulative survival

0.50

HD

PD

0.25

0.00

0

12

24

36

48

60

72

84

96

108

120

Duration in months

Source: 21st MDTR Report 2013, NRR

table 3 2 2 unadjusted patient survival by year of entry 2004 2013
Table 3.2.2: Unadjusted patient survival by year of entry, 2004-2013

Source: 21st MDTR Report 2013, NRR

figure 3 2 2 unadjusted patient survival by year of entry 2004 2013
Figure 3.2.2: Unadjusted patient survival by year of entry, 2004-2013

Kaplan-Meier survival estimates, by yrcom

1.00

Yr 2013

Yr 2012

0.75

Yr 2011

Yr 2010

Yr 2009

Yr 2008

Cumulative survival

0.50

Yr 2007

Yr 2006

Yr 2004

Yr 2005

0.25

0.00

0

12

24

36

48

60

72

84

96

108

120

Duration in months

Source: 21st MDTR Report 2013, NRR

table 3 2 4 unadjusted patient survival by diabetes mellitus status 2004 2013
Table 3.2.4: Unadjusted patient survival by diabetes mellitus status, 2004-2013

Source: 21st MDTR Report 2013, NRR

figure 3 2 4 unadjusted patient survival by diabetes mellitus status 2004 2013
Figure 3.2.4: Unadjusted patient survival by diabetes mellitus status, 2004-2013

Kaplan-Meier survival estimates, by Diabetes

1.00

0.75

Cumulative survival

0.50

Non-diabetic

0.25

Diabetic

0.00

0

24

48

72

96

120

144

168

Duration in months

Source: 21st MDTR Report 2013, NRR

slide15
Figure 3.3.1(a): Variation in patient survival at 1-year among HD centres adjusted for age and diabetes mellitus status, 2008-2012

% HD survival at 1-year: 2004-2012 cohort

(lower 95% CI, upper 95% CI)

100

94.1

80

60

% survival

40

20

0

0

50

100

150

200

250

300

350

400

450

500

550

600

650

Centre

*Horizontal line represents the median % survival among HD centres

Source: 21st MDTR Report 2013, NRR

slide16
Figure 3.3.1(b): Funnel plot at 1-year among HD centres adjusted for age and diabetes mellitus status, 2008-2012 cohort

100

80

60

% survival

40

20

0

0

50

100

150

200

250

300

350

400

450

500

550

Number of HD Patients

Percentage survival

2 SD from mean

3 SD from mean

*Horizontal line represents the median % survival among HD centres

Source: 21st MDTR Report 2013, NRR

slide17
Figure 3.3.1(c): Variation in patient survival at 5-years among HD centres adjusted for age and diabetes mellitus status, 2004-2008

% HD survival at 5-year: 2002-2006 cohort

(lower 95% CI, upper 95% CI)

100

80

67.3

60

% survival

40

20

0

0

40

80

120

160

200

240

280

320

360

400

440

Centre

*Horizontal line represents the median % survival among HD centres

Source: 21st MDTR Report 2013, NRR

slide18
Figure 3.3.1(d): Funnel plot for patient survival at 5-years among HD centres adjusted age and diabetes mellitus, 2004-2008 cohort

100

80

60

% survival

40

20

0

0

50

100

150

200

250

Number of HD Patients

Percentage survival

2 SD from mean

3 SD from mean

*Horizontal line represents the median % survival among HD centres

Source: 21st MDTR Report 2013, NRR

slide19
Figure 3.3.2(a): Variation in patient survival at 1-year among PD centres adjusted for age and diabetes mellitus, 2008-2012

% PD survival at 1-year: 2004-2012 cohort

(lower 95% CI, upper 95% CI)

100

89.8

80

60

% survival

40

20

0

0

2

4

6

8

10

14

16

18

20

22

24

12

Centre

*Horizontal line represents the median % survival among PD centres

Source: 21st MDTR Report 2013, NRR

slide20
Figure 3.3.2(b): Funnel plot at 1-year among PD centres adjusted for age and diabetes mellitus status, 2008-2012 cohort

100

80

60

% survival

40

20

0

0

100

200

300

400

500

600

700

Number of PD Patients

Percentage survival

2 SD from mean

3 SD from mean

*Horizontal line represents mean of % survival among PD centres

Source: 21st MDTR Report 2013, NRR

slide21
Figure 3.3.2(c): Variation in patient survival at 5-years among PD centres adjusted for age and diabetes mellitus, 2004-2008

% PD survival at 5-year: 2002-2006 cohort

(lower 95% CI, upper 95% CI)

100

80

60

% survival

45

40

20

0

0

2

4

6

8

10

12

14

16

18

20

Centre

*Horizontal line represents the median % survival among PD centres

Source: 21st MDTR Report 2013, NRR

slide22
Figure 3.3.2(d): Funnel plot for patient survival at 5-years among HD centres adjusted age and diabetes mellitus, 2004-2008 cohort

100

80

60

% survival

40

20

0

0

50

100

150

200

250

Number of PD Patients

Percentage survival

2 SD from mean

3 SD from mean

*Horizontal line represents mean of % survival among PD centres

Source: 21st MDTR Report 2013, NRR

slide23
Table 3.4.1: Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality (2004-2013)

Source: 21st MDTR Report 2013, NRR

slide24

Figure 3.4.1(a): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by diastolic blood pressure (2004-2013 cohort)

Diastolic Blood Pressure (mmHg)

1.6

1.5

1.06

1.03

1

1

.86

Hazard ratio

.5

0

<70

70-<80

80-<90(ref*)

90-<100

>=100

Source: 21st MDTR Report 2013, NRR

slide25

Figure 3.4.1(b): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by serum phosphate (2004-2013 cohort)

Serum Phosphate (mmol/L)

2

1.86

1.5

Hazard ratio

1

1

.93

.92

.87

.5

0

<0.8

0.8-1.3(ref*)

1.3-1.8

1.8-2.2

>=2.2

Source: 21st MDTR Report 2013, NRR

slide26

Figure 3.4.1(c): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by hemoglobin (2004-2013 cohort)

Hemoglobin (g/dL)

2

1.77

1.5

Hazard ratio

1

1

.83

.5

0

<10

10-12(ref*)

>=12

Source: 21st MDTR Report 2013, NRR

slide27
Table 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality (2004-2013 cohort)

Source: 21st MDTR Report 2013, NRR

slide28
Figure 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality by Kt/V (2004-2013 cohort)

KT/V-HD

1.46

1.5

1.23

1.14

1.08

1

1

Hazard ratio

.5

0

<1

1-<1.2

1.2-<1.4(ref*)

1.4-<1.6

>=1.6

Source: 21st MDTR Report 2013, NRR

slide29
Table 3.4.3: Adjusted hazard ratio for mortality of PD patients uncensored for change of modality (2004-2013 cohort)

Source: 21st MDTR Report 2013, NRR

figure 3 4 4 a variations in ramr by hd centre 2012
Figure 3.4.4(a): Variations in RAMR by HD centre, 2012

(lower 95% CI, Upper 95% CI)

100

90

80

70

60

50

RAMR

40

30

20

10

0

0

50

100

150

200

250

300

350

400

450

500

550

600

Centre

Source: 21st MDTR Report 2013, NRR

figure 3 4 4 b funnel plot of ramr by hd centre 2012
Figure 3.4.4(b): Funnel plot of RAMR by HD centre, 2012

100

90

80

70

60

50

RAMR

40

30

20

10

0

20

50

80

110

140

170

200

230

260

290

320

350

380

Number of patients in the centre

99% Control Limit

95% Control Limit

Source: 21st MDTR Report 2013, NRR

figure 3 4 5 a variations in ramr by pd centres 2012
Figure 3.4.5(a): Variations in RAMR by PD centres, 2012

(lower 95% CI, Upper 95% CI)

22

20

18

16

14

12

Centre

10

8

6

4

2

0

0

5

10

15

20

25

30

35

40

45

50

55

60

RAMR

Source: 21st MDTR Report 2013, NRR

figure 3 4 5 b funnel plot for ramr by pd centres 2012
Figure 3.4.5(b): Funnel plot for RAMR by PD centres, 2012

60

55

50

45

40

35

RAMR

30

25

20

15

10

5

0

0

50

100

150

200

250

300

350

400

450

500

Number of patients in the centre

99% Control Limit

95% Control Limit

Source: 21st MDTR Report 2013, NRR