The Association Between Lifestyle and All-Cause Mortality in Patients Undergoing Maintenance Hemodialysis: A 3-year Prospective, Observational Study.

Abstract

Purpose: Lifestyle is one of the important factors affecting health. There are few studies that comprehensively analyze the impact of a combination of lifestyle factors on mortality in patients undergoing maintenance hemodialysis. So, to measure the association between lifestyle factors and mortality for patients undergoing maintenance hemodialysis.

Patients and methods: A prospective, observational study design was employed. Through convenience sampling, the patients who are over 18 years old and have undergone dialysis for at least 3 months, from the hemodialysis center outpatient in two hospitals of Xi'an were selected. The questionnaires of this study include sociodemographic characteristics and lifestyle-related scales, such as nutrition, sleep and self-management scales. The differences between the deceased group and the surviving group were analyzed using the t-test or Mann-Whitney tests and chi-square tests. Logistic regression analysis was applied to identify the association between lifestyle factors and mortality.

Results: In this study, 286 patients who completed the questionnaire were screened. During the follow-up of this 3 years, patients who transferred to another hospital (n=31), kidney transplantation (n=6) and termination of dialysis (n=13) were excluded. Finally, 236 participants were tracked to the final outcome. Of these 236 patients, 66.95% were men. The proportion of patients under 60 years old is slightly higher than that of patients over 60 years old. More than half (64.83%) of the patients have a lower education level. And the main primary disease of ESRD was diabetic nephropathy (39.83%). Through a 3-year follow-up study, 73 patients died, accounting for 30.93%. The results showed that compared with surviving patients, deceased patients had significantly lower scores of self-management (Z=-2.09, P=0.036) and higher scores of malnutrition-inflammation score (Z=-2.31, P=0.021). Moreover, deceased patients had a significantly higher proportion of poor sleepers (χ²=4.38, P=0.036) and No exercise (χ²=5.16, P=0.023). However, there were no statistically significant differences in BMI, smoking history and drinking history between the two groups. In logistic analyses, age (χ²=19.63, P<0.001, OR=0.26, 95% CI=0.14~0.47) and self-management score (χ²=3.82, P=0.051, OR=1.03, 95% CI=1.00~1.06) were major factors related to mortality.

Conclusion: Self-management and age are closely related to the mortality rate of patients. And our study showed that the relationship between self-management and mortality is strongest, so doctors and nurses at dialysis centers should pay more attention to and actively improve self-management level of patients undergoing maintenance hemodialysis.