Annual Mortality Rate for Hemodialysis Patients
The annual mortality rate for hemodialysis patients ranges from approximately 17-20% in the United States, with significant regional variations worldwide, including lower rates in countries like Japan (less than 10%) and varying rates across different regions in China (up to 11.2%). 1
Regional Variations in Hemodialysis Mortality
- In the United States, the annual mortality rate for hemodialysis patients has historically been around 20% per year (as of 2002 data), with some improvement noted in the HEMO Study showing approximately 17% annual mortality 1
- In China, according to the 2017-2018 China Kidney Disease Network (CK-NET) data report, regional variations exist with the highest mortality rate for hemodialysis patients observed in Zhejiang province at 11.2% in 2017 1
- Japan consistently demonstrates significantly better survival outcomes with annual mortality rates less than 10%, which cannot be explained by differences in statistical methodology according to the Dialysis Outcomes and Practice Patterns Study (DOPPS) 1
Factors Affecting Mortality in Hemodialysis Patients
Patient-Related Risk Factors
- Advanced age, white race, and diabetes are associated with significantly increased risk of death in hemodialysis patients 2
- Low serum albumin (<40 g/L) is highly associated with increased mortality, suggesting inadequate nutrition may be an important contributing factor 2
- Low serum creatinine (not high) is paradoxically associated with higher death risk, potentially reflecting poor muscle mass and nutritional status 2, 3
Treatment-Related Factors
- Dialysis adequacy impacts survival, with higher urea index (Kt/V ≥1.4) associated with relative risk reduction in both diabetic (41%) and non-diabetic (33%) patients compared to lower Kt/V values 4
- Dialysis time, when adjusted for adequate Kt/V (0.8-1.2), does not significantly correlate with mortality rates 3
- Use of recombinant human erythropoietin has been associated with improved mortality rates (8.3% vs 19.2% in patients not receiving it) 3
Cardiovascular Factors
- Cardiovascular disease is highly prevalent among dialysis patients (43.01% in 2017 according to CK-NET data), with coronary heart disease (37.26%) and heart failure (14.51%) being the most common 1
- Paradoxically, predialysis systolic hypertension (160-189 mmHg) has been associated with better survival compared to normal or low blood pressure values in hemodialysis patients, a phenomenon termed "reverse epidemiology" 5
Hospitalization and In-Hospital Mortality
- The all-cause hospitalization rate for dialysis patients was reported as 2.42 per person per year in 2017 1
- In-hospital mortality rates for hemodialysis patients were reported at 1.23% per hospitalization event 1
- Cardiovascular disease was the most frequent cause of hospitalization among hemodialysis patients (33.68%) 1
Patient Perception vs. Reality
- Hemodialysis patients tend to be more optimistic about their prognosis than their nephrologists 6
- While patients' expectations about 1-year survival may be relatively accurate (93% actual 1-year survival in one study), longer-term survival expectations dramatically overestimate actual outcomes (56% survival by 23 months) 6
- Patient prognostic expectations are associated with treatment preferences, with those expecting better survival more likely to prefer life-extending care 6
Key Considerations for Clinicians
- The high mortality rate in hemodialysis patients necessitates careful monitoring of modifiable risk factors, particularly nutritional status as reflected by albumin and creatinine levels 2, 3
- Regional variations in mortality highlight the importance of examining local practices and patient characteristics that may contribute to better outcomes 1
- The paradoxical relationship between certain clinical parameters (like blood pressure) and outcomes in dialysis patients suggests that treatment goals for the general population may not always apply to this specialized population 5