A Single Center Analysis Of Related Factors For Mortality With Maintenance Hemodialysis

Objective： Analyze the clinical data and characteristics of patients onmaintenance hemodialysis in the second hospital of Jilin University, determinethose factors contribute to the mortality. Therefore, we can control the modifiablefactors to reduce the mortality.Methods：Analyze the171cases of patients of CKD5on maintenance hemodialy-sis which were diagnosed in the second hospital of Jilin University from January2011to June2014retrospectively. Baseline demographic data such as age, gender,cause of ESRD, and comorbidities such as diabetes, hypertension, cardiovasculardisease, cerebrovascular disease, infaction, left ventricular hypertrophy, peripheralvascular disease, and malignancy,emergency dialysis, predialysis labs,dialysisprescription and vascular access are collected. These patients can be divided intodeath group and survival group according to the prognosis. Comparing thedifference between the above indexes, so as to explore the related factors aboutmortality of MHD.Results:1.General situation:(1) Male to female ratio was1.25:1in death group, Male to female ratio was1.10:1in survival group. The gender distribution of death group and survival grouphad no statistical difference(P＞0.05).(2) the average age of survival group is55.39±15.35, the average age of death group is65.03±16.49, the death group was obviouslygreater than the survival group about the average age, there was a significantdifference(P＜0.01)；there was a significant difference about the death rate betweendifferent groups(x2=11.815,P＜0.05),the related risk of death also increased with advancing age.(3)The primary causes of MHD patients are chronic nephritis anddiabetic nephropathy in the survival group and the death group, there was nodifference between the survival group and the death group about the cause of MHD（x2=3.526，P＞0.05）.The RR of mortality is higher in diabetic nephropathy patientsthan the non-diabetic nephritis patients.(4) A central venous catheter (CVC) was usedby87.2％and a native arteriovenous (A-V) fistula for HD access was usedby12.8%in the death group.CVC was used by76.5％and A-V fistula was used by23.5%in the survival group,The vascular access of death group and survival grouphad no statistical difference (P＞0.05).(5) There is statistically significant betweendifferent groups about the CCI in the survival group and the death group (x2=34.438,P<0.05),as the number of comorbidities increased,the RR for mortality increased aswell.2.eGFR: The average eGFR of survival group is6.51mL/min/1.73m2, theaverage eGFR of death group is8.59mL/min/1.73m2, the death group was higherthan the survival group about the eGFR, there was statistically significantdifferences (P＜0.05).Mean age was higher with higher eGFR at the time ofinitiating HD.The percentage of individuals with mortality increases with highereGFR values(P＜0.05).While the percentage of hemoglobin＞90g/L,serumalbumin＞35g/L and A-VF decreses with higher eGFR.there was no statisticallysignificant differences (P＞0.05).3.predialysis labs: There was statistically significant differences betweenferritin, serum prealbumin, serum creatinine, urinary inhibition C, serum calcium andparathyroid hormone (P＜0.05). There was no statistical difference between serumalbumin, hemoglobin, blood phosphorus and Ca×P (P＞0.05).4.the causes of death and time:There were39deaths among the171maintenancehemodialysis patients.Mortality during the first year remains the highest(24cases).The top three primary cause of death is cardiovascular disease, infection,and cerebrovascular disease. Conclusion:1.The primary causes of MHD patients are chronic nephritis and diabeticnephropathy;2.Age, comorbidity index,high serum calcium are independent risk factors ofdeath among the maintenance hemodialysis patients;3.Mortality during the first year remains the highest.The top three primarycause of death is cardiovascular disease, infection, and cerebrovascular disease.