Survival estimates for 683 patients starting dialysis from 1970 through 1989: identification of risk factors for survival.

Survival estimates were performed on 683 chronic dialysis patients who started dialysis from 1970 through 1989 and followed through 1991. Patients were grouped by dialysis type, renal diagnosis, start-year group and age at start. During these 20 entry, years, the median starting age rose from 47 to 61 years. Patients with a renal diagnosis of diabetes mellitus or renal vascular disease increased to 41% of those starting dialysis during the last 8 years of study. Survival analysis for all of the 683 patients revealed a 51-month median survival and a 43% and 23% 5- and 10-year survival estimates, respectively. There was nearly a fourfold rise in the risk ratio as age increased from the youngest to oldest age groups. Home hemodialysis patients had the longest survival, 89% at 5 years; patients on CAPD had a 56% 5-year survival. In-center hemodialysis patients had a median survival of 48 months and a 5-year survival of 39%. Pairwise comparisons of the renal diagnostic groups found patients with polycystic kidneys, interstitial disease and chronic glomerulonephritis to have better survival than patients with diabetes mellitus, renal vascular disease or the "other" diagnoses (log-rank test, p < 0.001). Survival analyses showed age, renal diagnosis, race, type of dialysis and dialysis modality switch to be important predictors of survival. The results of the survival estimates, gross mortality rates and standardized mortality ratios were used as guides to the adequacy of dialysis and quality of care delivered for the years 1989 through 1992.