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ORIGINAL ARTICLE
Year : 2016  |  Volume : 5  |  Issue : 4  |  Page : 255-260

Predictors of mortality among patients on maintenance hemodialysis


Department of Nephrology, Andhra Medical College, Visakhapatnam, Andhra Pradesh, India

Correspondence Address:
G Prasad
Department of Nephrology, King George Hospital, Visakhapatnam, Andhra Pradesh
India
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Source of Support: None, Conflict of Interest: None


DOI: 10.4103/2277-8632.196558

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Context: Despite the continuous improvement of dialysis technology and pharmacological treatment, mortality rates for dialysis patients were still high. A 2-year prospective study was conducted at a tertiary care hospital to determine the factors influencing survival among patients on maintenance hemodialysis. Patients and Methods: A total of 198 patients with end-stage renal disease who were started on hemodialysis (8 h/week) were studied. Follow-up was censored at the time of death or at the end of the 2-year study period, whichever occurred first. Statistical Analysis Used: The Statistical Package for the Social Sciences version 15.0, Stata 8.0, MedCalc 9.0.1, and Systat 11.0 were used for data analysis. Results: Of the 198 patients studied (mean age 49.95 ± 14.55 years, 68.3% male and 50.56% diabetics), 107 died with an estimated mortality rate of 54.04% at 1 year. On an age-adjusted multivariate analysis, female gender and independently predicted mortality. In Cox analyses, patient survival was associated with female sex, low serum albumin, native kidney urine output, presence of left ventricular hypertrophy (LVH) (ejection fraction <50% on two-dimensional echocardiography), compliance to dialysis, and interdialytic weight gain independently predicted mortality. There was no significant difference between diabetes and nondiabetes in relation to death (Relative Risk = 0.214; 95% CI = 0.005-10.02, P = 0.005). Conclusions: This study revealed that mortality among hemodialysis patients remained high mostly due to sepsis and ischemic heart disease. Patient survival was better with good native kidney urine output, adequate serum albumin, absence of LVH and ejection fraction >50% on two-dimensional echocardiography, compliance to dialysis, and interdialytic weight gain <3 kg. Comprehensive predialytic nephrology care prevents mortality and improves survival among hemodialysis patients.


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