Mortality Predictors after 10 Years of Dialysis

Abstract

Background: This work aimed to examine the predictive value for death of various clinical variables after long-term hemodialysis (HD).Design, setting, participants, and measurements: A total of 947 patients (597 men and 350 women, aged 21 to 93 yr) who were undergoing maintenance HD in Niigata, Japan, were stratified into two cohorts: Those with >10 yr of prior HD at study enrollment (n ‫؍‬ 391) and those with <10 yr of previous therapy (n ‫؍‬ 556). The survival of patients was examined for up to 40 mo (1999 to 2003) with the Cox proportional hazards model. Baseline clinical and dialysis data and serum biochemistries were used as independent variables. For adjustment for bias in patient selection, patient survival in either cohort was analyzed separately.Results: In patients with >10 yr of HD, high pulse pressure, cerebrovascular disease, low serum creatinine, and low Kt/V values were the mortality risk predictors, whereas for those with <10 yr of HD, age and cerebrovascular disease were independent risk predictors for death. Diabetes, coronary artery disease, serum albumin, and C-reactive protein were NS predictors in those with long-term HD.Conclusions: Providing adequate dosage of dialysis and achieving a better control of pulse pressure may further improve survival in selected patients who had undergone HD for >10 yr.

Estudo epidemiológico da doença renal crônica terminal no oeste do Paraná: uma experiência de 878 casos atendidos em 25 anos

“…However, an improvement in the quality of dialysis and availability of new medications (erythropoietin, sevelamer) has occurred in the last period studied, as shown in Figure 3. The annual mortality in patients on HD in other studies has varied from approximately 10% in Japan, 25 16.3% in Italy 26 to over 20% in Mexico. 27 Regarding the causes of death in patients on RRT, the cardiovascular cause has been the most common.…”

“…We reviewed the medical records of all patients undergoing dialysis (HD or peritoneal dialysis) in the past 25 The dialysis modality chosen was conventional HD, three sessions per week, each session lasting three to four hours. Continuous ambulatory peritoneal dialysis was indicated when vascular access lacked or when patients had better socioeconomic conditions and a profile adequate for the procedure.…”

Avaliação da qualidade de vida em pacientes em hemodiálise e sua relação com índice de massa corporal e creatinina sérica

“…Vale ressaltar que a literatura tem comprovado a relação do IMC e da creatinina sérica com a sobrevida dos pacientes submetidos à hemodiálise (AJIRO et al, 2007;NOORI et al, 2010;JOHANSEN;LEE, 2015). Nos pacientes em hemodiálise, alto IMC (>30kg/m²) não está associado com risco de mortalidade.…”

“…A explicação para este evento, paradoxal, seria as maiores reservas musculares além do tecido adiposo em excesso nos pacientes (JOHANSEN;LEE, 2015). A creatinina sérica também está envolvida em um paradoxo quando relacionada à sobrevivência e à QV visto que os estudos indicam que menores concentrações se associam a maior risco de morte em pacientes submetidos à hemodiálise (LOWRIE; LEW, 1990;LIMA et al, 1995;AJIRO et al, 2007). A influência negativa dos baixos níveis pode estar relacionada ao pobre estado nutricional uma vez que pacientes com maiores níveis de creatinina sérica podem ter maior massa protéica somática (AJIRO et al, 2007).…”

Comparative Outcomes between Hemo- and Peritoneal Dialysis Patients with Acute Intracerebral Hemorrhage

“…Stroke accounts for 4.0–17% of deaths in the ESRD population and also results in significant morbidity [2,16]. The prognosis of ICH in chronic dialysis patients is especially poor.…”