Nephrol Dial Transplant (2004) 19: 108-120
© ERA–EDTA 2003; all rights reserved
Original Article
Mortality and hospitalization in haemodialysis patients in five European countries: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS)
1Department of Renal Medicine, Birmingham Heartlands Hospital, Birmingham, UK, 2University Renal Research and Education Association, Ann Arbor, Michigan, USA, 3Nephrology Section, University of Heidelberg, Heidelberg, Germany, 4Nephrology Department, Lapeyronie University Hospital, Montpellier, France, 5Clinic for Nephrology, Hypertension and Dialysis, Augusta-Kranken-Anstalt, Ruhr University, Bochum, Germany, 6Department of Nephrology and Dialysis, A. Manzoni Hospital, Lecco, Italy, 7Nephrology Service, Hospital General Vall d’Hebron, Barcelona, Spain, 8Center for Clinical Epidemiology and Biostatistics, University of Pennsylvania, Philadelphia, Pennsylvania, USA and 9Department of Biostatistics, School of Public Health, University of Michigan, Ann Arbor, Michigan, USA
Correspondence and offprint requests to: Dr Friedrich K. Port, MD, MS, University Renal Research and Education Association, 315 W. Huron St, Suite 260, Ann Arbor, MI 48103, USA. Email: fport{at}urrea.org
Background. Mortality and hospitalization rates are reported for nationally representative random samples of haemodialysis patients treated at randomly selected dialysis facilities in five European countries participating in the Dialysis Outcomes and Practice Pattern Study (DOPPS) (France, Germany, Italy, Spain and the UK).
Results. In the UK, 28.1% of haemodialysis patients received prior peritoneal dialysis treatment compared with 4.2–8.3% in other countries. Kidney transplantation rates ranged from 3.3 (per 100 patient years) in Italy to 11.6 in Spain. The relative risk (RR) of mortality, adjusted for age, sex and diabetes status was significantly higher in the UK (RR = 1.39, P = 0.02) compared with Italy (reference) and increased in association with age (RR = 1.60 for every 10 years older, P <0.001), diabetes as cause of end-stage renal disease (ESRD) (RR = 1.55, P < 0.001), male patients <65 years (RR = 1.29, P = 0.02) and peritoneal dialysis in the 12 months prior to starting haemodialysis (RR = 1.72, P = 0.06). Hospitalization for cardiovascular disease was highest in France and Germany (0.40 and 0.43 hospitalizations per patient year, respectively) and lowest in the UK (0.19), although cardiovascular comorbidity was similar in the UK and France. Hospitalization rates for vascular access-related infection ranged from 0.01 hospitalizations per patient year in Italy to 0.08 in the UK, consistent with the higher dialysis catheter use in the UK (25%) vs Italy (5%). Hospitalization risk was significantly higher in France than in other Euro-DOPPS countries and was significantly (P < 0.05) associated with prior peritoneal dialysis therapy, peripheral vascular disease, gastrointestinal bleeding in the prior 12 months, diabetes, cancer, cardiac disease, psychiatric disease and recent onset of ESRD (within 30 days of study entry).
Conclusions. The large differences in haemodialysis practice and outcomes in the Euro-DOPPS countries suggest opportunities for improvement in patient care.
Keywords: haemodialysis; hospitalization; international comparison; mortality; outcomes; practice patterns
Present address: D. A. Goodkin, ICOS Corp., Bothell, Washington, USA.
Professor E. Hecking died 18 September 2002
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