Survival Study of Dialysis Patients in Taiwan

• Main Authors: Tze-Wah Kao, 高芷華
• Other Authors: Jung-Der Wang
• Format: Others
• Language: en_US
• Published: 2012
• Online Access: http://ndltd.ncl.edu.tw/handle/43882331228495878851

博士 === 國立臺灣大學 === 職業醫學與工業衛生研究所 === 100 === Introduction The survival time of dialysis patients is generally shorter than that of a healthy population. Factors that affect the survival of dialysis patients include age, residual renal function, malnutrition, inflammation, diabetic status, depression, social support, and health-related quality of life (HRQOL). The existence and extent of vascular calcification are also strong predictors of cardiovascular morbidity and mortality in patients with end-stage renal disease (ESRD). However, the latter correlations are mainly shown in hemodialysis (HD) patients and have not been completely investigated in peritoneal dialysis (PD) patients. Whether HD or PD is better in terms of patient survival has long been under debate as all previous comparison results were not yielded from large randomized clinical trials. Knowing the causes of morbidity and mortality in dialysis patients will help in the successful implementation of methods to improve the survival of these patients. With the extension of human life expectancy and the increase of chronic diseases, both the numbers of dialysis patients in the world and in Taiwan are rising. The prevalence of ESRD in Taiwan has been constantly high due to the full coverage of National Health Insurance and the high quality of dialysis treatment. To extend the survival of dialysis patients in Taiwan without jeopardizing their health-related quality of life or the corresponding national economic burden is consequential. Therefore, the issue of providing ESRD patients with cost-effective dialysis and good HRQOL is currently of utmost importance. Goals of Study (1) To estimate the survival time of dialysis patients in Taiwan and to determine the factors that affect their survival (2) To measure the lifetime quality of life scores of dialysis patients in Taiwan (3) To measure the yearly and lifetime cost of dialysis patients in Taiwan. Results of Study (1) After matching, HD and PD patients had similar life expectancy and expected years of life lost. Survival was better for diabetic patients if they received HD. (2) The lifetime QOL scores of physical functioning and role emotional were higher in HD than in PD patients. When the dialysis vintage was 3 years or less, PD patients had significantly higher QOL scores than HD patients in social functioning and mental health. After 3 years of dialysis, however, HD patients were found to have significantly higher QOL scores than PD patients in 5 domains. (3) In Taiwan, the total lifetime costs paid by the NHI for PD patients were significantly lower than those for HD patients. Conclusions of Study Survival between HD and PD patients in Taiwan was not different. As PD patients had higher QOL scores of social functioning and mental health in the first 3 years of dialysis, and the total lifetime costs paid by the NHI were lower for PD than for HD patients, we recommend that PD might be promoted as the first-line dialysis therapy followed by HD in later years. Among patients with poorly-controlled diabetes mellitus and multiple comorbidities, however, HD should be considered first.