Death in dialysis

Abstract

Purpose: To analyze all patients who died while on hemodialysis from a single institution 1995–2004 and determine factors that influence duration on HD (months). Material and Methods: Review of the EMR from the dialysis unit for demographics, treatment parameters, cause of death, laboratory data. Two main groups those who stop dialysis (SHD) vs non stop dialysis (NSHD) data as mean and SD. Observations done at the start/mid/end of the period on dialysis by Kaplan Meier analysis. Results: 348 deaths, reported SMR for 2000–93(0.36,0.48,0.72,0.79), average comorbidity index 7.1–16.4; 49.1% male; age 67.6(12.3); 58.2% DM, 117(33.6%) stop dialysis. Detail analysis from 2000–2004; 187 deaths; 33.6% catheter, 41.1% AV graft at the time of death; 26% on no BP meds at the end, 64% 1–2 BP meds at the end. Cause Stop No Stop CV 33(28%) 145(62.7%) Infection 10(8.5%) 41(17.7%) Other 74(63.5%) 45(19.6%) Most SHD deaths due to uremia (60%), Cancer 17%, occurred 36% CVA. SHD vs NSHD: older 70.8 (12.9) vs 65.9(12.9) p < 0.001. No difference in average months in dialysis 41.2 (38.9) vs 48.7(47.7)NS, in URR (start/end), UF during Hd, predialysis MAP (start/end: 105(15) 196(15)/95 (20) , 96(20)) albumin, phosphorous. Lower creatinine (at the end 6.2(1.5) 7.4(2.4)) higher Kt/V at end 1.47(0.4) vs 1.29(0.3). BMI lower at star/mid/end of the observation period. Conclusions: A large proportion of deaths were due to discontinuation of dialysis, older patient discontinue dialysis more frequently, the length of time on dialysis (months) is related more to nutritional factors (creatinine, BMI)