Highlights

• From 1995 -2013, a 12% – 27% decrease over 5-year periods was experienced in deaths related to Kidney failure in the United States.

• Over time, a reduction in excess mortality was observed for all ages and both during treatment with dialysis as well as during time with a transplant for functioning kidney.

On average, people with kidney failure have a higher risk of dying prematurely than those who don’t however, it has been observed that the excess risk is fast reducing. This fact was from a study to be published in the Clinical Journal of the American Society of Nephrology (CJASN), and is an encouraging statistic showing the efforts geared towards improved health care haven’t been a waste.

It is yet to be ascertained if the improvements observed merely reflect parallel improvements in the general population despite the fact that we have seen a significant reduction in the premature demise of people due to kidney failure. Bethany foster, MD, MSCE (Montreal Children’s Hospital and the Research Institute of the McGill University Health Centre) and Benjamin Laskin, MD, MSCE (The Children’s Hospital of Philadelphia) led a team to investigate this. They studied the changes in the excess risk of early death against that of the general population while considering those who have been treated for kidney failure here in the United States.

The study focused on the 1,938,148 children and adults who have been diagnosed with kidney failure from 1995 – 2013. A variation based on age was observed over 5 year periods and this variation included a 12% decrease for 65 year olds while a decrease of 27% was observed for people less than 14 years old. During dialysis (treatment), as well as during functioning kidney transplant; the youngest individuals with a functioning kidney transplant recorded the highest relative improvement while the oldest patients recorded the overall highest decrease in the excess kidney failure related deaths.

We observed that over the past 22 years, all age groups have witnessed significant improvements in mortality risk and while some were as a result of better access to kidney transplantation and extended survival of transplant patients, some others could be attributed to the improvement in the care offered to people treated with dialysis and those with kidney transplant as noted by DR. Foster. Considering the amount of resources that have been invested into caring for patients, this is quite important and the investments have significantly improved the situation.

Dr. Foster stated that apart from the late adolescents and eely adults, they expected to record decreased mortality rates for all age groups and that’s because the late adolescents and early adults usually have difficulty adhering to recommended treatments and in some cases, the transfer of young people from pediatric health care facilities to adult care facilities results in a breakdown in continuity of care. It was observed that young people in this group recorded no improved mortality risk between 1995 and 2006 unlike al other groups. However, significant improvements were observed after 2006 and that is because of increased sensitization of the healthcare practitioners to these issues I the early 200s and this resulted in a different approach in how young people are cared for.

The gap in mortality risk between people with kidney failure and those who don’t is present, although it is gradually diminishing. As noted by Dr. Foster, kidney transplant is still one of the best ways of caring for people with kidney failure and a major impediment to this is the lack of  – or inadequate – amount of suitable organs for the transplant. Organ donation is something that people have to start thinking of.

Kirsten Johansen, MD (University of California, San Francisco), in a following editorial highlighted the framework for future studies for those who wish to examine the specific changes that can practice patterns and clinical patterns can contribute to a significant mortality risk decrease in patients with ESRD. She stated that Analyses of differences in results over certain periods across geographic regions are great tools that can be applied to gain insight into the impact changes or variations in practices on survival.