Dialysis-related mortality in the United States

BACKGROUND In the United States, the gross mortality rate for patients undergoing dialysis in 1992 was 23.6% per year, higher than in any other industrialized country. This mortality rate has been rising slightly for the last 10 years. Wide variations in mortality rates exist among states and among dialysis centers, and smaller dialysis centers have higher mortality rates than larger ones. PURPOSE To review the possible reasons for the high mortality rate associated with dialysis in the United States.

SUMMARY Differences in patient populations do not explain the variations in mortality rates. The incidence of new patients and the prevalence of older patients and patients with diabetes are higher in the United States than in other countries and are continuing to rise. However, these numbers are rising in other countries as well without a concomitant increase in their mortal' ity rates. Black patients make up a disproportionate number of US dialysis patients, but they are less likely to die than white patients. US patients spend less time per week in dialysis than their European counterparts and use smaller dialyzers, resulting in lower clearance of solutes.

CONCLUSION Approximately two thirds of US patients receive inadequate dialysis. Nephrologists must examine their practices and their outcomes to improve the quality of care they give.