Abstract
Backgroundoptimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority.Methodswe performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox’s proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values.ResultsData from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39–5.12), serum iron (HR = 8.396, 95% CI: 2.02–34.96), serum calcium (HR = 4.102, 95% CI: 1.35–12.46) and serum protein (HR = 4.630, 95% CI: 2.07–10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01–0.74), high ferritin values (HR = 0.392, 95% CI: 0.19–0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19–0.61) and serum albumin (HR = 0.230, 95% CI: 0.10–0.54) were less risk to die.Conclusionsurvival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.
Highlights
Chronic Kidney Disease (CKD) and its evolution to endstage renal disease (ESRD) is increasingly recognized as a serious risk factor for mortality, being considered an unquestionable global public priority [1,2,3,4]
Our study provided a set of indicators and parameters that showed to be was an important prognostic factor for survival of patients in the first year of treatment in HD, such as: basic cause of ESRD, serum phosphorus, serum calcium, leukocytes, serum protein, serum albumin, serum iron and ferritin
We found a significant difference in the values of serum albumin, in which individuals in HD with serum albumin ≥4.0, had an Hazard Ratio (HR) of 0.230
Summary
Chronic Kidney Disease (CKD) and its evolution to endstage renal disease (ESRD) is increasingly recognized as a serious risk factor for mortality, being considered an unquestionable global public priority [1,2,3,4]. Data from the 2017 Annual Report of the European Renal Association - European Dialysis and Transplant Association (ERA-EDTA) [7] report that 83.311 individuals from all countries of Europe started RRT in 2016. At the end of the same year, the total number of individuals requiring RRT was 564.638, with more than 80% being on hemodialysis (HD). In Brazil, in 2017, the total number of patients on chronic dialysis was equivalent to 162.583, with 91.8% of patients undergoing HD and 85% of this treatment modality funded by the Unified Health System (SUS) [8, 9]
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