Life expectancy on dialysis.

[flip]

You're my kind of person, Roadrunner. I still love wilderness camping and don't think dialysis will ever stop me from doing it.

I strongly disagree with the mortality rates. My center is private and nonprofit and the death rate is extremely low. The for profit centers like Davita and Fresenius have a much higher rate. Home hemo, either daily or nocturnal, is about as good as a transplant.

[petey]

Roadrunner, you and your husband sound like Marvin and me.  We have always been involved in Dixie Youth Baseball (which is similar to Little League) and have now coached for 23 years -- Marvin with the "older" ones (ages 9-11) and me with the "little" ones (ages 6-8).  Even though we don't have any children, we have actually helped "raise" many children in our community.  When he first went on dialysis, all of our family was sad for Marvin because he would have to give up his volunteer coaching -- or so they thought.  Marvin decided he wouldn't do that.  (His words -- "If I die out on that field, I'll die doing something I love, which is better than dying sitting in my recliner at the house!")  Since he's been on dialysis, he's coached for an extra 13 years and also had his teams advance all the way to four STATE tournaments (and his team was runners-up in the state of NC two years in a row).  If he had "retired" from his volunteer coaching when he first went on dialysis, he would have missed working with about 650 little boys and girls -- and they wouldn't have had the opportunity to play for him.  Now, don't get me wrong -- he can't coach exactly like he did before he got sick; he's had to make some adjustments because of his physical limitations.  But, he's still coaching...still loving it...still good at it...still going.

Home hemo, either daily or nocturnal, is about as good as a transplant.

Flip -- I know you made this statement referring to mortality rates, but we think it's also applicable for energy, stamina, overall health, etc., too.  Marvin feels just about as good now (home hemo) as he did when he had his transplant, and his labs are just as good as during his transplant.  But, we're still hoping for another transplant.......

[stauffenberg]

The problem always is that there is one lab value which is never the same on dialysis as with a successful transplant, and that is the creatinine level.  Even right after hemodialysis sessions patients are often going home with a creatinine of 300+, but with a successful transplant, the creatinine will range between 80 and 130 all the time.  Since it was demonstrated in 1995 that creatinine is toxic, causing accelerated athero- and arteriosclerosis, an elevated level will always pull down the life expectancy.

[Zach]

Since it was demonstrated in 1995 that creatinine is toxic, causing accelerated athero- and arteriosclerosis, an elevated level will always pull down the life expectancy.

Is it not true that some of the immunosuppressive drugs taken after transplants also cause accelerated athero- and arteriosclerosis?

[stauffenberg]

Quite right!  But my point only was that patients shouldn't assume that just because their nephrologists tell them their lab results are 'okay' that this means they are normal.  It just means that the small subset of the total blood chemisty selected for measurement to determine the adequacy of the dialysis dose is within a tolerable range.

[meadowlandsnj]

The problem always is that there is one lab value which is never the same on dialysis as with a successful transplant, and that is the creatinine level.  Even right after hemodialysis sessions patients are often going home with a creatinine of 300+, but with a successful transplant, the creatinine will range between 80 and 130 all the time.  Since it was demonstrated in 1995 that creatinine is toxic, causing accelerated athero- and arteriosclerosis, an elevated level will always pull down the life expectancy.

When I had my transplant my creatnine never went below 1.7.  It usually hovered around 1.8 and 2.2.

Donna

 

[stauffenberg]

Physiologic values for a normal, healthy kidney or a well-functioning transplant on the scale you are using would range from a creatinine level of 0.7 to 1.3.

[Bill Peckham]

Physiologic values for a normal, healthy kidney or a well-functioning transplant on the scale you are using would range from a creatinine level of 0.7 to 1.3.

"Normal" varies by gender and age too. More important is the trend over time. Even somewhat diminished function (Levels in the 2s) if stable, are acceptable.

[stauffenberg]

Creatinine is TOXIC.  Anything higher than the normal range of 0.7 to 1.3 may be classified as 'acceptable' in the world of dialysis where it is a given that good health outcomes are impossible, but 'acceptable' is not equivalent to 'healthy,' as the vastly foreshortened life expectancy of dialysis patients demonstrates.

[Bill Peckham]

Creatinine is TOXIC.  Anything higher than the normal range of 0.7 to 1.3 may be classified as 'acceptable' in the world of dialysis where it is a given that good health outcomes are impossible, but 'acceptable' is not equivalent to 'healthy,' as the vastly foreshortened life expectancy of dialysis patients demonstrates.

People live a long time - nearly a normal life span - with stage 2 CKD, and Stage 3 CKD if their function does not continue to decline.

[flip]

I'm not going to worry about it. I will continue to go to dialysis, wear my seatbelt and obey the speed limits, go to the basement when a tornado comes, and not run with scissors. Hopefully, my life will be long and fruitful.

[okarol]

I wish there were new updates - this article is the most recent I can find that mentions life expectancy.http://ihatedialysis.com/forum/index.php?topic=4536.0  There must be more current info somewhere.

[pelagia]

This isn't exactly what you are looking for Okarol, but it seems important so I thought I'd post it. The article compares survival on daily in-center hemo versus the standard in-center 3x per week protocol.  I can download the paper through the university system, so if anyone would like to read the entire article, please let me know.  It's so new that it hasn't even been assigned page numbers yet.  I bolded the conclusion at the end for emphasis.

Nephrol Dial Transplant (2008) 1 of 7
doi: 10.1093/ndt/gfn210

Short daily haemodialysis: survival in 415 patients treated for 1006 patient-years

Carl M. Kjellstrand1, Umberto Buoncristiani2, George Ting3, Jules Traeger4, Giordina B. Piccoli5,Roula Sibai-Galland6, Bessie Ann Young7 and Christopher R. Blagg7

1Loyola University, Chicago, IL, USA, 2HS Silvestrini, Perugia, Italy, 3El Camino Hospital, Mountain View, CA, USA, 4Claude Bernard University, Lyon, France, 5University Hospital of Turin, Italy, 6AURAL-Lyon, France and 7Northwest Kidney Centers and University of Washington, Seattle, WA, USA

Abstract

Background. Survival statistics for daily haemodialysis are lacking as most centres providing this have treated only a small number of patients for short observation times. We
pooled our 23-year, 1006-patient-year, five-centre experience of 415 patients treated by short daily haemodialysis.

Methods. One hundred and fifty patients were treated in-centre, most because of medical complications and 265 by home or self-care haemodialysis. Patients were on daily
haemodialysis for 29 ± 31 (0–272) months. Forty-two percent had primary and 31% had secondary renal failure. Treatment time was 136 ± 35 min, frequency 5.8 ± 0.5 times/week and weekly stdKt/V 2.7 ± 0.55.

Results. Eighty-five patients (20%) died; 5-year cumulative survival was 68 ± 4.1% and 10-year survival was 42 ± 9%. Age, secondary renal failure and in-centre dialysis were associated with mortality, while gender, frequency of dialysis (5, 6 or 7 per week), continent, country and blood access were not. Survival was compared with matched patients from the USRDS 2005 Data Report using the standardized mortality ratio and cumulative survival curves. Both comparisons showed that the survival of the daily haemodialysis patients was 2–3 times higher and the predicted 50% survival time 2.3–10.9 years longer than that of the matched US haemodialysis patients. Survival of patients dialyzing daily at home was similar to that of age-matched recipients of deceased donor renal transplants.

Conclusions. Survival of patients on short daily haemodialysis was 2–3 times better than that of matched three times weekly haemodialysis patients reported by the USRDS.

USRDS = US Renal Data System

[okarol]

Does this (Results. Eighty-five patients (20%) died; 5-year cumulative survival was 68 ± 4.1% and 10-year survival was 42 ± 9%. ) mean that 85 patients died before 5 years?

[pelagia]

I'm on a different computer at home and don't have the paper in front of me, but my guess is that, yes, that is what they are saying.  It's difficult with these sorts of studies to know exactly what the patient population looks like demographically, economically, etc., so it may be best to look at the results in a comparative way.  Overall they found that Daily short hemo is better than the 3x a week schedule.  And, they also noted that "Survival of patients dialyzing daily at home was similar to that of age-matched recipients of deceased donor renal transplants."

[Meinuk]

Karol,

Bill has written quite a bit about this (see his post earlier in this thread).

Also on the Kjellstrand paper in May of this year.  (actually giving Mark's article a plug) http://www.billpeckham.com/from_the_sharp_end_of_the/2008/05/more-on-kjellst.html

A lot of people are dissecting this data.  It is good news for Dialysis. (home dialysis that is!)

[pelagia]

Bill has written quite a bit about this (see his post earlier in this thread).

Meinuk, thanks for pointing out the earlier posts on the same topic and the same paper.  Here's the link Bill posted in May re. the lifespan data in the USRDS:

http://www.billpeckham.com/from_the_sharp_end_of_the/2008/03/dialysis-lifesp.html

I missed the earlier discussion, which was right around the time my husband was getting his transplant.  Well, I seem to miss a lot of stuff here anyway...

[okarol]

Thanks pelagia and Meinuk - the data looks promising.

[stauffenberg]

If you look closely at the studies done showing the life expectancy benefits with short daily dialysis they are based on inferences from EXTREMELY SHORT TIME SPANS, and since death rates expand exponentially as a function of time spent on dialysis, I think it is a statistically bold inference to project these results over the long term.  The decisive limiting factor to the life expectancy of patients on short daily dialysis is going to be death from lack of vascular access, which kills 15% of dialysis patients, but which has not even been taken into account in the studies showing the benefits of short daily dialysis, since it is a cause of mortality which only becomes measurable after a number of years have been spent on dialysis.

[Meinuk]

True Stauffenburg, the data and treatment is so new that there is no long term study.

I agree with your citing vascular data, although, you should point out that you are quoting data that was gathered on overall vascular system health of subjects who were relegated to 3x a week minimum dosage, at maximum stress (flowrate).  No wonder their circulatory systems failed after all of that stress.

I bet that when Jonas Salk announced the Polio vaccine, you would have questioned him, and denounced him for not having any long term studies before he went public with the vaccine.  It is just in your personality.

I am taking these numbers as an early sign that there is a brighter future in short daily and nocturnal dialysis.  The trend is positive, and growing, wait a few years, and you'll have all the empirical data you'll need.

[G-Ma]

yeah meinuk, also, vascular access failure due to so many different some uncaring people/professionals.

[Zach]

The decisive limiting factor to the life expectancy of patients on short daily dialysis is going to be death from lack of vascular access, which kills 15% of dialysis patients, but which has not even been taken into account in the studies showing the benefits of short daily dialysis, since it is a cause of mortality which only becomes measurable after a number of years have been spent on dialysis.

Please give us a link to this statistic.

Are these mainly patients in their 70s and 80s? Newly-diagnosed renal failure without warning?  Your numbers often tell the story, but only part of the story.  And what about the use of those wonderful Permacaths that you have promoted?

There's more to the statistic of 15% deaths due to lack of vascular access than you are stating (which is no surprise).
 

[flip]

Who really cares about meaningless statistics?  Zach is a good example of life expectancy on dialysis. Stauffenberg is just "stirrin' up shit" and I refuse to smell it. I hate dialysis just like everyone else on here but I'm not going to quit living just because someone's statistics tell me that I'm supposed to. Trust me, dear friends, I'm gonna be around for a long long time.

[G-Ma]

Exactly flip, which is why we are all here...to outwit those damn stats.  I didn't like them in the corp world and I like them even less now. So, let's drink a toast to that. 

[paris]

Zach is my "stat" and hero!