Predictors of Clinical Outcomes in Hemodialysis Patients: a Multicenter Observational Study

Authors

  • Tayebeh Soleymanian Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
  • Hossein Niyazi Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences-International Branch, Tehran, Iran
  • Shaghayegh Noorbakhsh Jafari Dehkordi Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences-International Branch, Tehran, Iran
  • Shokoufeh Savaj Firouzgar Hospital, Iran University of Medical Sciences, Tehran, Iran
  • Hassan Argani Urology and Nephrology Research Center, Modares Hospital, Shahid Beheshti University of Medical Sciences, Tehran, Iran
  • Iraj Najafi Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran

Abstract

Introduction. Cardiovascular and noncardiovascular mortality and morbidity rates of hemodialysis patients are high despite improvement in dialysis delivery.

Materials and Methods. Hemodialysis patients (n = 532) from 9 hemodialysis facilities were enrolled in this cohort study in September 2012. Causes of death, hospitalization, and hemodialysis exit were recorded during a 28-month follow-up period. A Cox proportional hazard model was used to predict death adjusting for case-mix variables, nutrition variables, bone mineral variables, Kt/V, vascular access, and Charlson comorbidities index.

Results. Patients were 56.0 ± 15.4 years old (57% men). A total of 161 patients (30%) died (17 per 100 patient years), and the most common causes of death were cardiovascular diseases (42%) and infections (25%). Transplantation rate was 7 per 100 patient years and hospitalization frequency was 0.76 per patient year. Based on the multivariable Cox proportional hazard model, the mortality hazard ratio was 1.03 (95% confidence interval [CI], 1.01 to 1.05; P = .007) for age (years), 0.21 (95% CI, 0.11 to 0.40; P < .001) for serum albumin (g/dL), 1.21 (95% CI, 1.03 to 1.42; P = .02) for serum phosphorus (mg/dL), 1.001 (95% CI, 1.0005 to 1.002; P = .001) for serum intact parathyroid hormone (pg/mL), 1.58 (95% CI, 1.01 to 2.51; P = .047) for hemodialysis catheter (compared to arteriovenous fistula), and 1.75 (95% CI, 1.59 to 1.94; P < .001) for the Charlson score.

Conclusions. Nutritional factors, comorbidities, vascular access, and abnormal mineral metabolism are the main determinants of mortality and morbidity in hemodialysis patients.

Author Biography

  • Tayebeh Soleymanian, Nephrology Research Center, Shariati Hospital, Tehran University of Medical Sciences, Tehran, Iran
    nephrology, associate professor

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Published

2017-05-31

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Section

ORIGINAL | Dialysis