Effect of end-stage renal disease on long-term survival after a first-ever mechanical ventilation: A population-based study

Abstract

Introduction: Patients with end-stage renal disease (ESRD Pos) usually have multiple comorbidities and are predisposed to acute organ failure and in-hospital mortality. We assessed the effect of ESRD on the poorly understood long-term mortality risk after a first-ever mechanical ventilation (1-MV) for acute respiratory failure. Methods: The data source was Taiwan's National Health Insurance (NHI) Research Database. All patients given a 1-MV between 1999 and 2008 from one million randomly selected NHI beneficiaries were identified (n = 38,659). Patients with or without ESRD (ESRD Neg) after a 1-MV between 1999 and 2008 were retrospectively compared and followed from the index admission date to death or the end of 2011. ESRD Pos patients (n = 1185; mean age: 65.9 years; men: 51.5 %) were individually matched to ESRD Neg patients (ratio: 1:8) using a propensity score method. The primary outcome was death after a 1-MV. The effect of ESRD on the risk of death after MV was assessed. A Cox proportional hazard regression model was used to assess how ESRD affected the mortality risk after a 1-MV. Results: The baseline characteristics of the two cohorts were balanced, but the incidence of mortality was higher in ESRD Pos patients than in ESRD Neg patients (342.30 versus 179.67 per 1000 person-years; P <0.001; covariate-adjusted hazard ratio: 1.43; 95 % confidence interval: 1.31-1.51). For patients who survived until discharge, ESRD was not associated with long-term (>4 years) mortality. Conclusions: ESRD increased the mortality risk after a 1-MV, but long-term survival seemed similar.