| Background: Maintenance hemodialysis is an important treatment of end-stage renal disease patients. Patients under hemodialysis have higher mortality than general people. Thus, identifying the factors associated with death in maintenance hemodialysis(MHD) patients is vital. Survival of MHD patients varies between 1 month to 20 years or more. It is unspecified whether characteristics and survival risk factors of long-time survival MHD patients are different to those of shorter-time survival patients. Besides,some studie's report that hemodialysis patients who are expected to die have certain clinical and biochemical characteristics. However, little is known on the state of dialysis patients preceding death, especially in our country. Thus, we analyzed the risk factors for MHD patients with different survival time to find if there were differences between them. We also aimed to determine the characteristics of dying patients and the factors associated with death in MHD patients.Methods: Two parts were included in this study. In the first part, we retrospectively collected data of 392 MHD patients who entered hemodialysis therapy between 2004 and 2014 (followed up to December, 2015) at the PLA General Hospital.Then we used Cox regression to estimate adjusted hazard ratios (HR) measuring associations between patient characteristics and mortality in each survive interval (3-12 months, 13-36 months, 37-60 months and 61-144 months). In the second part, we retrospectively collected data of 4104 participants from 16 blood purification centers in China from January 2012 to December 2014. We divided them into two groups based on their survival status:the survival group and the death group, then, we compared the characteristic between the two groups. Further we performed logistic regression analysis to determine factors associated with all-cause mortality.Results: In total 392 patients were enrolled in the first part. The COX analysis showed that, low level of albumin (HR=0.849, 95%CI: 0.750-0.962) was a risk factor for mortality in patients survived 3-12 months. Patients with high level of albumin(HR=0.909, 95%CI: 0.831-0.993) or triglyceride ? 1.7 mmol/L (HR=0.209, 95%CI:0.080-0.543) had lower death risk. Aging (HR=1.057, 95%CI: 1.021-1.095) and diabetic nephropathy (HR=2.959, 95%CI: 1.239-7.070) were associated with mortality in patients survived 3-12 months. Aging was the only risk factor for mortality in patients survived 37-60 and 61-144 months (37-60 months: HR=1.064, 95%CI: 1.021-1.110,61-144 months: HR=1.096, 95%CI: 1.041-1.153). In the second part, 4104 patients were included. Compared with the survival group, the death group had more men, and more patients with diabetic nephropathy (DN) and hypertensive nephropathy (HTN).Patients preceding death also had lower levels of diastolic blood pressure, hemoglobin,serum albumin, serum calcium, serum phosphate, spKt/V and higher age. Multivariate analysis revealed that male sex (OR= 1.437, 95% CI: 1.094-1.886), age (OR=1.046, 95%CI: 1.036-1.057), presence of DN (OR=1.837, 95% CI: 1.322-2.552), lower serum calcium (OR=0.585, 95% CI: 0.346-0.989), hemoglobin (OR=0.974, 95% Cl:0.967-0.981) and albumin (OR=0.939, 95% CI: 0.915-0.963) levels were risk factors associated with mortality.Conclusions: Risk factors for mortality are different in patients with different survival time. And hemodialysis patients preceding death have definite characteristics.Knowing the risk factors in different periods is useful to judge prognosis and intervention. |
PDF Full Text Request