What is the mortality rate for patients requiring emergent dialysis?

Mortality Rates in Patients Requiring Emergent Dialysis

The mortality rate for patients requiring emergent dialysis is extremely high, with overall mortality ranging from 18.7% to 30% depending on the underlying cause and comorbidities. 1

Mortality by Underlying Cause

End-Stage Renal Disease (ESRD)

• Overall mortality rate: approximately 23% annually 2
• Sudden cardiac death accounts for 25% of all-cause mortality and 60% of cardiac deaths in dialysis patients 2
• First-year mortality rate exceeds 20 deaths per 100 dialysis patient-years 1
• Some centers experience annual mortality rates of approximately 30% 1

Ethylene Glycol Poisoning

• Overall mortality: 18.7% 1
• Early poisoning (glycolate ≤12 mmol/L): 3.6% mortality 1
• Late poisoning (glycolate >12 mmol/L): 20.4% mortality 1
• Median time to death: 96 hours (24-264 hours) 1

Multiple Myeloma with Acute Light Chain Cast Nephropathy

• Mortality correlates with baseline kidney function 1
• Dialysis-dependent patients: median overall survival of 5.2 months 1
• Patients with eGFR 30-45 ml/min: median overall survival of 16.4 months 1

ST-Elevation Myocardial Infarction with Renal Failure

• Dialysis patients: 21.3% in-hospital mortality 1
• End-stage renal failure not on dialysis: 11.7% in-hospital mortality 1
• GRACE registry: approximately 30% in-hospital mortality for STEMI patients with stage 4-5 CKD 1

Mortality by Time Period

Short-term Mortality

• Cardiac arrest during hemodialysis: 7 events per 100,000 dialysis sessions 1
• Survival to hospital discharge after cardiac arrest in dialysis centers: 30% overall 1
• Survival for VT/VF cardiac arrest in dialysis centers: 38% 1

Long-term Mortality

• 5-year survival for dialysis patients: approximately 50% 3
• Comparable to or worse than many cancers:
  • Worse than breast cancer (82.1% 5-year survival) 3
  • Worse than prostate cancer (83.3% 5-year survival) 3
  • Worse than colorectal cancer (56% 5-year survival) 3
  • Better than lung cancer (14-19.7% 5-year survival) 3
  • Better than pancreatic cancer (9.1-9.4% 5-year survival) 3

Risk Factors for Increased Mortality

Patient Factors

• Advanced age (HR=1.26, p<0.0002) 4
• Diabetes mellitus 4, 5
• Cardiovascular disease (HR=2.91, p<0.001) 4, 5
• Inflammation (HR=1.15, p<0.03) 4
• Malnutrition (low albumin and prealbumin levels) 4
• Atherogenic index of plasma >0.24 (HR=2.1, p<0.002) 4
• Prolonged duration on dialysis 5

Cause-Specific Mortality

• Cardiovascular causes: 51.7% of deaths 5
• Infections: 36% of deaths in some cohorts 6
• Withdrawal from dialysis: 21.2% of deaths, more common in patients over 61 years 6
• Sudden death/unknown: 27.5% of deaths 5

Clinical Implications

• Emergent dialysis situations require immediate and aggressive intervention
• Cardiac monitoring is essential as sudden cardiac death is a major risk
• Automatic external defibrillators should be available in all dialysis units 1
• Basic life support training for dialysis staff is recommended 1
• Particular attention should be paid to infection prevention and cardiovascular support
• Elderly patients beginning maintenance dialysis should be informed that their 10-year survival probability is comparable to that of pancreatic and lung cancer 3

The high mortality rates associated with emergent dialysis highlight the need for early intervention in patients with deteriorating renal function and for comprehensive management of comorbidities, particularly cardiovascular disease and infections, which are the leading causes of death in this population.