A Retrospective Study On The Dialysis Timing Of Single-center Hemodialysis Patients

Objective:Through the retrospective study on the clinical data and hemodialysis time of339 end-stage renal disease(ESRD)patients,the article explore the relationship between the blood dialysis timing of ESRD patients and the prognosis,and the risk factors affect the prognosis of ESRD patients.Methods:The article collect the hemodialysis clinical data of the ESRD patients visiting our blood dialysis center from January 1,2007 to January 1,2017.According to the inclusion and exclusion criteria of this study,the study has included 339 cases of hemodialysis patients.EGFR calculated according to MDRD formula divides the study objects into group A(eGFR≤5ml/min/1.73m~2),group B(5ml/min/1.73m~2<eGFR≤10ml/min/1.73m~2),group C(10ml/min/1.73m~2<eGFR≤15ml/min/1.73m~2)and group D(eGFR>15ml/min/1.73m~2).The article compares the age when starting hemodialysis,sex,first vascular access,basic diseases,clinical manifestations and complications,laboratory indicators,clinical outcomes and survival time of the four groups.Results:1.EGFR distribution:the eGFR value range when the patients starting hemodialysis in this study is 1.38-36.82ml/min/1.73m~2 and the average of eGFR is(7.47±4.43)ml/min/1.73m~2.The eGFR when starting the blood dialysis is mostly below 10ml/min/1.73m~2.2.Gender and age distribution:Among the 339 patients,there are 188 male cases(55.46%),151 female cases(44.54%)and the sex ratio is 1.24:1.The age when starting hemodialysis is between 20 and 86 years old and the average of age is(56.36±14.03)years.3.Basic diseases:Among the 339 cases of patients,there are 130 cases whose basic disease is diabetic nephropathy(38.35%),followed by primary renal disease which is 117 cases(34.51%)and 40 cases of hypertensive nephropathy(11.80%).The most of common basic diseases in group A are primary renal diseases and the most of common basic diseases in other three groups are diabetic renal diseases.4.Clinical symptoms and complications during initial hemodialysis:the clinical manifestations of initial hemodialysis are mainly respiratory difficulties(60.8%),followed by gastrointestinal symptoms(20.9%).Among them,the neurological symptoms and gastrointestinal symptoms are the highest in group A and respiratory difficulties and fatigue symptoms are the highest in group D.Among the complications of initial hemodialysis,there are 326 cases with renal anemia(96.2%)which is the highest in proportion,followed by 277 cases of electrolyte disorder(81.7%).Group A of patients with the complications of electrolyte disorder,renal anemia,uremic encephalopathy and secondary hyperparathyroidism take the largest proportion,while the group D of patients with cardiac insufficiency,lung infection,and body cavity effusion take the largest proportion.5.Laboratory indexes:the differences among renal function indexes(serum creatinine,blood urea nitrogen,uric acid),electrolyte(blood potassium,calcium,phosphorus),blood routine indexes(hemoglobin,platelet),albumin and parathyroid hormone of the four groups are of statistically significance(P<0.05).The differences among blood sodium,liver function indexes(ALT,AST),blood lipid(cholesterol and triglyceride)and coagulation function(PT,APTT)are with no statistically significance(P<0.05).6.The cause of death:the cause of death of the patients in this study has cardiovascular factor in 54 cases(62.80%),cerebral vascular factor in 9 cases(10.46%)and respiratory system disease in 9 cases(10.46%),infection factor in 9cases(10.46%)and other in 5 cases(5.82%).7.Survival rate and risk factors:the overall survival rate of 1 year,2 years,3years,5 years and 10 years of the four groups are respectively 96.6%,91.4%,82.3%,59.5%and 32.5%.The difference in survival rate of the four groups has no statistical significance(P>0.05).Age,the basic disease(diabetic nephropathy)and the creatinine value during hemodialysis are the risk factors.Conclusion:1.The most common primary disease of MHD patients in our dialysis center is diabetic nephropathy.2.The main causes of death of MHD patients is cardiovascular disease.3.It is not found that the timing of dialysis have an impact on the prognosis,but before hemodialysis of the patients,the proportion of complications such as electrolyte disorder,renal anemia and secondary hyperparathyroidism will increase gradually with the decrease of eGFR.4.This study concludes that age,serum creatinine level and diabetic nephropathy primary disease are the risk factors for the survival and prognosis of hemodialysis patients.