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Chapter 3 Death and Survival on Dialysis. Wong Hin Seng Ong Loke Meng. Source: 20 th MDTR Report 2012, NRR. Table 3.1.1: Deaths on dialysis 1993-2012. Source: 20 th MDTR Report 2012, NRR. Annual death rate on PD. Annual death rate on HD. 20. 15. Death rate. 10. 5. 0. '93. '94. - PowerPoint PPT Presentation
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Chapter 3Death and Survival on Dialysis
Wong Hin Seng
Ong Loke Meng
Source: 20th MDTR Report 2012, NRR
Table 3.1.1: Deaths on dialysis 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 3.1.1: Death rates on dialysis 1993-2012
Source: 20th MDTR Report 2012, NRR
0
5
10
15
20D
eath
rat
e
'93 '94 '95 '96 '97 '98 '99 '00 '01 '02 '03 '04 '05 '06 '07 '08 '09 '10 '11 '12Year
Annual death rate on PD Annual death rate on HD
Table 3.1.2 (a) : Causes of death on HD dialysis 1994-2012
Source: 20th MDTR Report 2012, NRR
Table 3.1.2 (b) : Causes of death on PD dialysis 1993-2012
Source: 20th MDTR Report 2012, NRR
Table 3.2.1(a): HD Patient survival (censored for change of modality)
Dialysis ModalityInterval (month)
HD
n % survival SE
0 50732 100
6 44662 94 0
12 39142 89 0
24 30203 79 0
36 23457 70 0
48 18043 63 0
60 13894 56 0
72 10651 50 0
84 8049 44 0
96 6167 39 0
108 4691 35 0
120 3609 31 0Source: 20th MDTR Report 2012, NRR
Table 3.2.1(b): PD Patient survival (censored for change of modality)
Dialysis ModalityInterval (month)
PD
n % survival SE
0 7072 100
6 6041 93 0
12 5010 87 0
24 3406 74 1
36 2314 62 1
48 1525 52 1
60 1040 44 1
72 690 37 1
84 445 32 1
96 288 26 1
108 191 23 1
120 110 20 1Source: 20th MDTR Report 2012, NRR
Table 3.2.1(c): HD Patient survival (not censored for change of modality)
Dialysis ModalityInterval (month)
HD
n % survival SE
0 50732 100
6 45292 94 0
12 40167 89 0
24 31477 79 0
36 24958 71 0
48 19544 63 0
60 15356 56 0
72 12025 51 0
84 9328 45 0
96 7334 41 0
108 5765 37 0
120 4588 33 0Source: 20th MDTR Report 2012, NRR
Table 3.2.1(d): PD Patient survival (not censored for change of modality)
Dialysis ModalityInterval (month)
PD
n % survival SE
0 7072 100
6 6256 93 0
12 5480 87 0
24 4181 74 1
36 3212 63 1
48 2423 54 1
60 1884 47 1
72 1484 42 1
84 1197 38 1
96 969 34 1
108 789 31 1
120 624 28 1Source: 20th MDTR Report 2012, NRR
Table 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 3.2.2(a): Unadjusted HD patient survival by year of entry, 1993-2012
Source: 20th MDTR Report 2012, NRR
Yr 2009-2012
Yr 2005-2008
Yr 2001-2004
Yr 1997-2000Yr 1993-1996
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Era
Table 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 3.2.2(b): Unadjusted PD patient survival by year of entry, 1993-2012
Source: 20th MDTR Report 2012, NRR
Yr 2009-2012
Yr 2005-2008
Yr 2001-2004
Yr 1997-2000
Yr 1993-19960.00
0.25
0.50
0.75
1.00
Cum
ula
tive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Era
Table 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 3.2.3(a): Unadjusted HD patient survival by age, 1993-2012
Source: 20th MDTR Report 2012, NRR
Age>=65
Age 55-64
Age 45-54
Age 35-44
Age 25-34Age 15-24
Age 1-14
0.00
0.20
0.40
0.60
0.80
1.00C
umu
lativ
e su
rviv
al
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by agegp
Table 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012
Source: 20th MDTR Report 2012, NRR
Figure 3.2.3(b): Unadjusted PD patient survival by age, 1993-2012
Source: 20th MDTR Report 2012, NRR
Age>=65Age 55-64
Age 45-54
Age 35-44
Age 25-34
Age 15-24Age 1-14
0.00
0.20
0.40
0.60
0.80
1.00C
umu
lativ
e su
rviv
al
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by agegp
Table 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012
Diabetes statusInterval (month)
Non-diabetic Diabetic
n % survival SE n % survival SE
0 23246 100 27980 100
6 20715 95 0 24566 94 0
12 18551 91 0 21160 87 0
24 14966 84 0 15567 74 0
36 12264 78 0 11343 63 0
48 10037 73 0 8032 54 0
60 8174 68 0 5649 45 0
72 6639 63 0 3859 38 0
84 5330 58 0 2501 31 0
96 4284 54 0 1623 25 0
108 3417 50 0 1010 20 0
120 2712 46 0 640 16 0
Source: 20th MDTR Report 2012, NRR
Figure 3.2.4(a): Unadjusted HD patient survival by diabetes mellitus status, 1993-2012
Source: 20th MDTR Report 2012, NRR
Diabetic
Non-diabetic
0.00
0.25
0.50
0.75
1.00
Cum
ulat
ive
surv
ival
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Diabetes
Table 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012
Diabetes statusInterval (month)
Non-diabetic Diabetic
n % survival SE n % survival SE
0 4173 100 3747 100
6 3653 95 0 3057 90 0
12 3082 91 0 2426 81 1
24 2220 82 1 1473 61 1
36 1626 75 1 852 44 1
48 1145 67 1 463 31 1
60 829 62 1 247 21 1
72 589 56 1 128 15 1
84 389 49 1 69 10 1
96 256 42 1 36 7 1
108 171 37 2 17 4 1
120 101 34 2 6 2 1
Source: 20th MDTR Report 2012, NRR
Figure 3.2.4(b): Unadjusted PD patient survival by diabetes mellitus status, 1993-2012
Source: 20th MDTR Report 2012, NRR
Diabetic
Non-diabetic
0.00
0.25
0.50
0.75
1.00C
umu
lativ
e su
rviv
al
0 24 48 72 96 120 144 168 192 216 240Duration in months
Kaplan-Meier survival estimates, by Diabetes
Figure 3.3.1(a): Variation in patient survival at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
10095.4
% s
urvi
val
0 50 100 150 200 250 300 350 400 450 500 550 600 650 700Centre
(lower 95% CI, upper 95% CI)% HD survival at 1-year: 1993-2011 cohort
*Horizontal line represents the median % survival among HD centres
Figure 3.3.1(b): Funnel plot for adjusted age at 1-year among HD centres adjusted for age and diabetes mellitus status, 1993-2011cohor
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100%
sur
viva
l
0 50 100 150 200 250 300 350 400 450 500 550 600 650Number of HD Patients
Percentage survival 2 SD from mean3 SD from mean
*Horizontal line represents the mean % survival among HD centres
Figure 3.3.1(c): Variation in patient survival at 5-years among HD centres adjusted for age and diabetes mellitus status, 1993-2007
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100
77.7
% s
urvi
val
0 40 80 120 160 200 240 280 320 360 400 440 480 520 560 600 640Centre
(lower 95% CI, upper 95% CI)% HD survival at 5-year: 2002-2006 cohort
*Horizontal line represents the median % survival among HD centres
Figure 3.3.1(d): Funnel plot for patient survival at 5-years among HD centres adjusted age and diabetes mellitus, 1993-2007cohort
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100%
sur
viva
l
0 50 100 150 200 250 300 350 400 450Number of HD Patients
Percentage survival 2 SD from mean3 SD from mean
*Horizontal line represents the mean % survival among HD centres
Figure 3.3.2(a): Variation in patient survival at 1-year among PD centres adjusted for age and diabetes mellitus , 1993-2011
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100
92.3
% s
urvi
val
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32 34 36 38 40Centre
(lower 95% CI, upper 95% CI)% PD survival at 1-year: 1993-2011 cohort
*Horizontal line represents the median% survival among PD centres
Figure 3.3.2(b): Funnel plot of 1-year patient survival from the 90th day of dialysis adjusted for age and diabetes mellitus among PD
centres, 1993-2011 cohort
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100%
surv
ival
0 100 200 300 400 500 600 700 800 900 1000Number of PD Patients
Percentage survival 2 SD from mean3 SD from mean
*Horizontal line represents the mean % survival among PD centres
Figure 3.3.2(c): Variation in patient survival at 5-years among PD centres adjusted for age and diabetes mellitus, 1993-2007
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100
58.8
% s
urvi
val
0 2 4 6 8 10 12 14 16 18 20 22 24 26 28 30 32Centre
(lower 95% CI, upper 95% CI)% PD survival at 5-year: 2002-2006 cohort
*Horizontal line represents the mean % survival among PD centres
Figure 3.3.2(d): Funnel plot of 5-years patient survival from 90 day of dialysis adjusted for age and diabetes mellitus among PD centres,
1993-2007 cohort
Source: 20th MDTR Report 2012, NRR
0
20
40
60
80
100%
surv
ival
0 50 100 150 200 250 300 350 400 450 500 550 600 650 700Number of PD Patients
Percentage survival 2 SD from mean3 SD from mean
*Horizontal line represents the median% survival among PD centres
Table 3.4.1: Adjusted hazard ratio for mortality of dialysis patients (not censored for change of modality (1993-2012) )
Figure 3.4.1(a): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by diastolic blood pressure (1993-
2012 cohort)
Source: 20th MDTR Report 2012, NRR
.78
1.01 1
1.15
1.73
0
.5
1
1.5
2H
azar
d ra
tio
<70 70-<80 80-<90(ref*) 90-<100 >=100
Diastolic Blood Pressure (mmHg)
Figure 3.4.1(b): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by serum phosphate (1993-2012
cohort)
Source: 20th MDTR Report 2012, NRR
1.59
1
.88.82 .83
0
.5
1
1.5
Haz
ard
ratio
<0.8 0.8-1.3(ref*) 1.3-1.8 1.8-2.2 >=2.2
Serum Phosphate (mmol/L)
Figure 3.4.1(c): Adjusted hazard ratio for mortality of dialysis patients uncensored for change of modality by hemoglobin (1993-2012 cohort)
Source: 20th MDTR Report 2012, NRR
.77
1
.82
1.11
0
.5
1
Haz
ard
ratio
<3.5 3.5-<4.5 (ref*) 4.5-<5.5 >=5.5
Calcium Phosphate Product (mmol2/L2)
Table 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality (1993-2012 cohort)
Figure 3.4.2: Adjusted hazard ratio for mortality of HD patients uncensored for change of modality by Prescribed Kt/V (1993-2012
cohort)
Source: 20th MDTR Report 2012, NRR
1.35
1.11
1
1.15
.96
0
.5
1
1.5
Haz
ard
ratio
<1 1-<1.2 1.2-<1.4(ref*) 1.4-<1.6 >=1.6
Prescribed KT/V-HD
Table 3.4.3: Adjusted hazard ratio for mortality of PD patients uncensored for change of modality (1993-2012 cohort)
Figure 3.4.4(a): Variations in RAMR by HD centre, 2011
Source: 20th MDTR Report 2012, NRR
0
10
20
30
40
50
60
70
80
90
100R
AM
R
0 50 100 150 200 250 300 350 400 450 500 550Centre
(lower 95% CI, Upper 95% CI)
Figure 3.4.4(b): Funnel plot of RAMR by HD centre, 2011
Source: 20th MDTR Report 2012, NRR
0
10
20
30
40
50
60
70
80
90
100R
AM
R
20 50 80 110 140 170 200 230 260 290 320 350 380Number of patients in the centre
99% Control Limit
95% Control Limit
Figure 3.4.5(a): Variations in RAMR by PD centres, 2011
Source: 20th MDTR Report 2012, NRR
0
2
4
6
8
10
12
14
16
18
20
22
24
26C
entr
e
0 5 10 15 20 25 30 35 40 45 50 55 60RAMR
(lower 95% CI, Upper 95% CI)
Figure 3.4.5(b): Funnel plot for RAMR by PD centres, 2011
Source: 20th MDTR Report 2012, NRR
0
5
10
15
20
25
30
35
40
45
50
RA
MR
20 50 80 110 140 170 200 230 260 290 320 350 380Number of patients in the centre
99% Control Limit
95% Control Limit
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