Abstract
Hemodialysis (HD) patients face long-term complications which require ongoing dialysis and follow-up. The management of hypertension among HD populations has often been neglected. This study aimed at identifying the determinants of death in hypertensive HD (HTN-HD) patients. In a multicenter retrospective cohort study (conducted from 2005 to 2018 in thirty-four HD centers affiliated with Shiraz University of Medical Sciences), the data of 725 HTN-HD patients who had at least 3 months of regular dialysis and follow-up were analyzed. Accelerated failure time mixture split-population (AFTMSP) regression was utilized to identify the factors with significant effects on long- and short-term overall survival (OS) separately. Among the different AFTMSP models, the extended generalized gamma (EGG) model outperformed the others. Sex (male: event time ratio [ETR]=1.30), initial vascular access type (arteriovenous fistula: ETR=1.50), and the type of membrane flux used for HD (high-flux: ETR=1.27) had important impacts on short-term OS. Moreover, age (OR=1.06), dialysis adequacy (Kt/ Vurea≤1.2: OR=2.30), initial vascular access type (central venous catheter: OR=2.08), serum sodium (OR=0.90) concentration, and potassium (OR=0.66) concentration had significant effects on long-term OS. The split-population analyses were able to demonstrate that the predictors of long-term OS were different from those of short-term OS. Although the superiority of the parametric EGG model was proved in this study, further research with different databases is suggested. Moreover, these findings can be considered by health policy decision-makers to create a new guideline to enhance the long-term OS of HTN-HD patients.
Highlights
Hemodialysis (HD) is a known option for renal replacement therapy
The results indicated that sex and initial vascular access type (AVF, event time ratio (ETR) [95% CI]: 1.50 [1.13–1.99], P = 0.005) had significant impacts on the short-term survival time
The management of hypertension among HD populations has often been neglected and the high cardiovascular mortality in these patients is often attributed to elevated blood pressure.[36]
Summary
Hemodialysis (HD) is a known option for renal replacement therapy. It prolongs the life of patients with end-stage renal disease, improves their quality of life, and reduces death from uremia.[1,2,3] Among various comorbid illnesses associated with this problem, hypertension is mentioned as the main one.[4,5,6] According to the reports, 18‒41% of patients with hypertension may need renal replacement therapy in the acute phase and the prevalence of hypertension varies from 70% to 90% among HD patients.[7,8] Hypertension is the initial cause of end-stage renal disease in about 30% of Iranian patients undergoing HD.[5]. This study aimed at identifying the determinants of death in hypertensive HD (HTN-HD) patients. Accelerated failure time mixture split-population (AFTMSP) regression was utilized to identify the factors with significant effects on long- and short-term overall survival (OS) separately. The superiority of the parametric EGG model was proved in this study, further research with different databases is suggested. These findings can be considered by health policy decision-makers to create a new guideline to enhance the long-term OS of HTN-HD patients. Prognosis and longterm overall survival in hypertensive patients undergoing chronic hemodialysis: a multicenter parametric mixture split-population analysis.
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