English

Abstract

BACKGROUND: Mortality risk among haemodialysis (HD) patients may be highest soon after initiation of HD. Studies from different geographical areas have been published regarding the predictors of early mortality among incident haemodialysis patients. With this background we started our study to asses early mortality causes among incident haemodialysis patients in our institute in Central India so that group of patients with risk factors can be educated and can be intervened early. MATERIALS & METHODS: 215 patients eligible for the evaluation of mortality in the first 120 days of dialysis were reviewed for their clinical and biochemical data. Univariate statistical tests using chi-square for binary variables and t-test for continuous variables were performed. RESULTS: The overall incident mortality within 120 days was 39 (18.1%) patients of which cardiovascular causes accounted for 51% of all the causes. Early mortality rate was not significantly increased in the comparison of gender groups but increased in patients with diabetes mellitus (29.4% vs.14.6%), those with reduced dialysis frequency (27.9% vs. 11.6%), the presence of low serum albumin (34.2% vs. 9.3%), the presence of a central venous catheter (26.7% vs. 10.1%) and the lack of Pre-ESRD nephrology care (23.6% vs. 11.6%) and in old age. The low serum albumin below 35 g/l was the strongest predictor of early mortality, the survival rates in patients with serum albumin less than 35 g/l and those with serum albumin equal to or greater than 35 g/l were 65.8% and 90.7%, respectively (p< 0.001). CONCLUSION: T he present study suggest that the important predictors of early mortality in the first 120 days of starting HD include the presence of diabetes mellitus, decreased frequency of dialysis sessions, the presence of low serum albumin, the presence of a central venous catheter, presence of urinary tract infection and the lack of Pre- ESRD nephrology care. These results also support the importance of arterio-venous fistula placement in the predialysis period with avoidance of temporary or permanent catheter placement and adequate predialysis nephrology care with a nephrologist at least 1 month before HD.