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Open Access Research article

Long-term survival and predictors for mortality among dialysis patients in an endemic area for chronic liver disease: a national cohort study in Taiwan

Chih-Chiang Chien12, Jhi-Joung Wang3, Yih-Min Sun4, Ding-Ping Sun56, Ming-Jen Sheu67, Shih-Feng Weng3, Chin-Chen Chu3, Hung-An Chen8, Chung-Ching Chio9, Jyh-Chang Hwang1, Yi-Hua Lu1, Hsien-Yi Wang16 and Wei-Chih Kan11011*

Author Affiliations

1 Department of Nephrology, Chi-Mei Medical Center, No.901, Zhonghua Rd, Tainan City, Yongkang Dist 710, Taiwan

2 Department of Food Nutrition, Chung Hwa University of Medical Technology, Tainan, Taiwan

3 Department of Medical Research, Chi-Mei Medical Center, Tainan, Taiwan

4 Department of Occupational Safety and Health, Chung Hwa University of Medical Technology, Tainan, Taiwan

5 Division of Transplantation, Chi-Mei Medical Center, Tainan, Taiwan

6 Chia Nan University of Pharmacy and Science, Tainan, Taiwan

7 Department of Gastroenterology, Chi-Mei Medical Center, Tainan, Taiwan

8 Department of Rheumatology, Chi-Mei Medical Center, Tainan, Taiwan

9 Department of Neurological Surgery, Chi-Mei Medical Center, Tainan, Taiwan

10 Department of Medical Laboratory Science and Biotechnology, Chung Hwa University of Medical Technology, Tainan, Taiwan

11 Institute of Biomedical Engineering, Southern Taiwan University, Tainan, Taiwan

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BMC Nephrology 2012, 13:43  doi:10.1186/1471-2369-13-43

Published: 18 June 2012

Abstract

Background

Patients with end-stage renal disease (ESRD) are at a higher risk for chronic hepatitis, liver cirrhosis (LC) and mortality than the general population. Optimal modalities of renal replacement therapy for ESRD patients with concomitant end-stage liver disease remain controversial. We investigated the long-term outcome for chronic liver disease among dialysis patients in an endemic area.

Methods

Using Taiwan’s National Health Insurance claim data (NHRI-NHIRD-99182), We performed a longitudinal cohort study to investigate the impact of comorbidities on mortality in dialysis patients. We followed up 11293 incident hemodialysis (HD) and 761 peritoneal dialysis (PD) patients from the start of dialysis until the date of death or the end of database period (December 31, 2008). A Cox proportional hazards model was used to identify the risk factors for all-cause mortality.

Results

Patients receiving PD tended to be younger and less likely to have comorbidities than those receiving HD. At the beginning of dialysis, a high prevalence rate (6.16 %) of LC was found. Other than well-known risk factors, LC (hazard ratio [HR] 1.473, 95 % CI: 1.329-1.634) and dementia (HR 1.376, 95 % CI: 1.083-1.750) were also independent predictors of mortality. Hypertension and mortality were inversely associated. Dialysis modality and three individual comorbidities (diabetes mellitus, chronic lung disease, and dementia) interacted significantly on mortality risk.

Conclusions

LC is an important predictor of mortality; however, the effect on mortality was not different between HD and PD patients.

Keywords:
Hemodialysis; Peritoneal dialysis; Mortality; Liver cirrhosis