Country and region specific adjusted relative risk of death (on a natural logarithmic scale) for incident patients on RRT (started RRT during the period 1996-2000 with follow up until December 31st 2003).
Cox regression was used to assess the relative risk of death (RR) for each region with adjustment for age, gender, diabetes, and additionally general population mortality. In patients on RRT the age, gender and diabetes adjusted RR of death was 0.65 (95% CI (0.64-0.66)) for South compared to North, while in the general population the age and gender standardized RR of death was 0.91. After adjustment for general population mortality in addition to age, gender, and diabetes, the RR of death for patients on RRT in the South changed from 0.65 to 0.74 (95% CI (0.72-0.75)), which indicates that general population mortality accounted for 26% of the region-related mortality difference on RRT.
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Country and region specific adjusted relative risk of death (on a natural logarithmic scale) for incident patients on RRT (started RRT during the period 1996-2000 with follow up until December 31st 2003). |
In conclusion, within Europe there exist considerable international differences in the mortality of patients on RRT. Twentysix percent of the European north-south mortality difference in RRT could be attributed to differences in general population mortality. Our data support the hypothesis that general population mortality is an important factor to take into account when making RRT mortality comparisons.
van Dijk PC, Zwinderman AH, Dekker FW, Schon S, Stel VS, Finne P, Jager KJ.
Effect of general population mortality on the north-south mortality gradient in patients on renal replacement therapy in Europe.
Kidney Int 2007;71:53-59.
References to other registry papers
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Care?: Data from the UK Renal Registry. Am J Transplant 2007;7:1167-1176.
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and calcium phosphate concentration product with outcomes in kidney transplant recipients. Transpl Int 2007;20:247-255.
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Paul van Dijk, Medical Informatician of the ERA-EDTA Registry