Predictors of Survival and Clinical Outcomes in Hemodialysis Patients: A 9-Year Multicenter Cohort Study.

Abstract

Introduction: Cardiovascular and non-cardiovascular mortality rates among hemodialysis patients continue to be high despite advances in dialysis therapy.

Materials and methods: This prospective cohort study enrolled 185 adult patients with end-stage kidney disease (ESKD) on maintenance hemodialysis (HD) from three hemodialysis facilities (Shariati hospital, Shohadaye Hafte-Tir hospital and Sevome-Sha'ban hospital ) in September 2012. Causes of death and HD exit were tracked over a follow-up period of 103 months (8.5 years). The Cox proportional hazards model was employed to predict mortality after adjusting for case-mix and laboratory data variables.

Results: The mean age of the patients was 57 ± 15.2 years, with a mean dialysis vintage of 39 ± 45 months. The cohort comprised 52.5% males and 48% diabetic patients. In the univariate analysis, mortality rate was higher among women (81% vs. 63%), diabetics (89% vs. 55%), and those with higher body mass index, older age, and lower serum creatinine, albumin, and intact PTH levels. A total of 132 patients (71%) died, with a mortality rate of 19 per 100 patient-years. The leading causes of death were cardiovascular diseases (47%) and infections (32.5%). Kidney transplantation was performed in 25 patients (14%), including 7 women and 18 men. The median survival was 4.1 years (95% CI: 3.3-5.0). The survival rates at one, two, three, five, and nine years were 83%, 64%, 56%, 39%, and 19%, respectively.

Conclusion: Older age, poor nutritional biomarkers, diabetes mellitus, and catheter vascular access are the primary factors contributing to poor long-term prognosis in hemodialysis patients.