Survival Rate Of Hemodialysis Patients Research Articles

Scattering effect for relative blood volume monitoring during hemodialysis

The long-term survival rate of hemodialysis patients is limited by hemodialysis-related complications, which are attributed to the inappropriate level of relative blood volume (RBV) after treatment. For the conventional optical monitoring methods, the RBV is usually overestimated, especially when the RBV varies in a wide range. Here, we find that the scattering effect of blood on incident light is the dominant factor of nonlinear measurement errors according to the numerical simulation results. Then a computational model considering both the absorption and scattering effect of blood is proposed and applied to a relative blood volume monitoring system (RBVMS). Finally, the RBVMS is validated in a commercial hemodialysis machine, showing a relatively low measurement error of 6.9 %. This result indicates the potential of the system for RBV monitoring during hemodialysis.

Survival Rate of Hemodialysis Patients and Its Predictors: A Multicentric Retrospective Cohort Study

Background: Despite advancements in medical and nursing care, the mortality rate among hemodialysis patients remains unexpectedly high. Objectives: This study aimed to evaluate the survival rates and identify mortality predictors among hemodialysis patients in Qazvin Province, Iran, over a five-year period from March 2015 to March 2020. Methods: This historical cohort study involved 378 hemodialysis patients from seven hospitals in Qazvin province, including Bu Ali Sina, Velayat, Razi, Alvand, Valiasr, Bueen Zahra, and Avaj, covering the period from March 21, 2015, to March 20, 2020. The study was based on data extracted from the patient's medical records, offering a detailed overview of their medical history and treatments during this timeframe. Results: The study revealed a median survival time of 38.5 months, with survival rates at 1, 2, 3, 4, and 5 years being 84.3%, 68.1%, 53.2%, 39.8%, and 18.0%, respectively. Cox regression analysis identified several key predictors of mortality. Mortality rates increased with age, higher levels of blood urea nitrogen, and when hemoglobin levels fell below 10 g/dL or calcium levels exceeded 9.5 mg/dL. Conversely, patients who underwent hemodialysis three times a week had higher levels of education, used fistula access, and experienced significantly lower mortality rates. Conclusions: The study highlighted the need for targeted interventions to improve both the survival rates and quality of life for hemodialysis patients in Qazvin Province. It emphasized the importance of careful monitoring and effective management of factors such as age, blood urea nitrogen, hemoglobin, and calcium levels, as well as the patients' educational background, frequency of dialysis sessions, and type of vascular access. By focusing on these aspects, healthcare professionals in the region could significantly enhance patient outcomes and prognoses in hemodialysis care.

Continuous Venovenous Hemofiltration is Associated with Improved Short-Term Survival Rate of Hemodialysis Patients with Acute Myocardial Infarction: A Single-Center Retrospective Study

Continuous Venovenous Hemofiltration is Associated with Improved Short-Term Survival Rate of Hemodialysis Patients with Acute Myocardial Infarction: A Single-Center Retrospective Study

Factors Influencing Hemodialysis Patients Survival Using Frailty Models

Abstract Background and objection: Hemodialysis is the most common renal replacement therapy in patients with End Stage Renal Disease (ESRD). This study investigated the 5-year survival rate of hemodialysis patients admitted to Imam Khomeini and Fatima Zahra Hospitals in Sari. Materials & Methods: This study was performed on 335 patients on hemodialysis referring to Imam Khomeini and Fatima Zahra Hospitals from November 2008 to November 2013. To investigate the factors influencing the patients' survival rate, we used Cox model and Frailty model and compared these models efficiency, we also applied the Akaikie information criterion and the residuals review. All calculations have been performed with SPSS version 20 & STATA version 8 and the significance level was 0.05. Findings: The results of this study showed that applying the Kaplan– Meier method to determine one, three and five year’s survival rates for hemodialysis patients were 74.9%, 53.2% and 20.4%, respectively. The mean survival time was 37.241 months. In the final model, in multivariate analysis of the gamma frailty model, the variables as age, education, marital status, diabetes, Kidney stone & obstructions, the clinic, the mean serum albumin and urea have been identified as the most important predictors in hemodialysis patients' survival (p < 0.05). Conclusion: According to the results of the frailty model fitness, the hemodialysis patients having the same explanatory variables also have different risk of death. Giving the Akaikie information criterion and the residuals review, the Weibull model with gamma frailty is more efficient than the Cox model and it has good fitness to the data.

The benefit of planned dialysis to early survival on hemodialysis versus peritoneal dialysis: a nationwide prospective multicenter study in Korea

Optimal preparation is recommended for patients with advanced chronic kidney disease to minimize complications during dialysis initiation. This study evaluated the effects of planned dialysis initiation on survival in patients undergoing incident hemodialysis and peritoneal dialysis. Patients newly diagnosed with end-stage kidney disease who started dialysis were enrolled in a multicenter prospective cohort study in Korea. Planned dialysis was defined as dialysis therapy initiated with permanent access and maintenance of the initial dialysis modality. A total of 2892 patients were followed up for a mean duration of 71.9 ± 36.7 months and 1280 (44.3%) patients initiated planned dialysis. The planned dialysis group showed lower mortality than the unplanned dialysis group during the 1st and 2nd years after dialysis initiation (1st year: adjusted hazard ratio [aHR] 0.51; 95% confidence interval [CI] 0.37–0.72; P < 0.001; 2nd year: aHR 0.71; 95% CI 0.52–0.98, P = 0.037). However, 2 years after dialysis initiation, mortality did not differ between the groups. Planned dialysis showed a better early survival rate in hemodialysis patients, but not in peritoneal dialysis patients. Particularly, infection-related mortality was reduced only in patients undergoing hemodialysis with planned dialysis initiation. Planned dialysis has survival benefits over unplanned dialysis in the first 2 years after dialysis initiation, especially in patients undergoing hemodialysis. It improved infection-related mortality during the early dialysis period.

Survival Rate of Hemodialysis Patients: A Competing Risk Analysis Approach

Background: Chronic kidney disease, a global health problem, leads to end-stage kidney disease, whose treatment requires long-term renal replacement therapy. The incidence of hemodialysis patients with end-stage kidney disease is increasing worldwide. The survival rate of hemodialysis patients is crucial for decision-making and planning. Objectives: This study aimed to determine the survival rate of hemodialysis patients and its related factors using the competing risk analysis approach to acquire more precise estimations of survival and mortality of the patients. Methods: This study was primarily based on medical records of hemodialysis patients who started dialysis from January 2011 to December 2017. The end of the study follow-up period was December 2021. The study included 214 eligible patients. Death was regarded as the event of interest, kidney transplantation as the competing risk, and other consequences as censored. We analyzed the data by cumulative incidence functions, Gray’s test, and Fine-Gray regression model using R version 4.1.2 and Stata v.16 at a significance level of 0.05. Results: The median age at the initiation of hemodialysis was 60 years. The risks of death in the first, second, third, fourth, and fifth years were 18.3%, 31.7%, 41.6%, 49.9%, and 60.9%, respectively. In the regression model, age at the initiation of hemodialysis (P-value = 0.000) and education (P-value = 0.000) were associated with mortality. Conclusions: Competing risk estimates of survival analysis of hemodialysis patients are more reliable than conventional approaches (e.g., Kaplan–Meier estimator) for planning and improving interventions and allocating resources. Detection of patients at a younger age and increasing patients' knowledge plays a significant role in improving their survival.

Development and validation of a nomogram for predicting the 6-months survival rate of patients undergoing incident hemodialysis in China

BackgroundThe all-cause mortality of patients undergoing hemodialysis (HD) is higher than in the general population. The first 6 months after dialysis are important for new patients. The aim of this study was to develop and validate a nomogram for predicting the 6-month survival rate of HD patients.MethodsA prediction model was constructed using a training cohort of 679 HD patients. Multivariate Cox regression analyses were performed to identify predictive factors. The identified factors were used to establish a nomogram. The performance of the nomogram was assessed using the C-index and calibration plots. The nomogram was validated by performing discrimination and calibration tests on an additional cohort of 173 HD patients.ResultsDuring a follow-up period of six months, 47 and 16 deaths occurred in the training cohort and validation cohort, respectively, representing a mortality rate of 7.3% and 9.2%, respectively. The nomogram comprised five commonly available predictors: age, temporary dialysis catheter, intradialytic hypotension, use of ACEi or ARB, and use of loop diuretics. The nomogram showed good discrimination in the training cohort [C-index 0.775(0.693–0.857)] and validation cohort [C-index 0.758(0.677–0.836)], as well as good calibration, indicating that the performance of the nomogram was good. The total score point was then divided into two risk classifications: low risk (0–90 points) and high risk (≥ 91 points). Further analysis showed that all-cause mortality was significantly different between the high-risk group and the low-risk group.ConclusionsThe constructed nomogram accurately predicted the 6-month survival rate of HD patients, and thus it can be used in clinical decision-making.

Trends in the incidence and prevalence of end-stage renal disease with hemodialysis in entire Korean population: A nationwide population-based study.

Data on the overall epidemiology and temporal trends of end-stage renal disease (ESRD) requiring hemodialysis in Korea are scarce. We aimed to estimate the prevalence and incidence of ESRD requiring hemodialysis in Korea between 2002 and 2017.Using the National Health Insurance Service database, we analyzed data from the entire Korean population between 2002 and 2017. Hemodialysis patients were identified using rare incurable disease codes (V001) or prescription of medical fee codes of hemodialysis (O7020 and O7021). We only included patients who had been maintained on hemodialysis for more than 90 days from the date of dialysis initiation, to exclude patients who required short-term dialysis for acute kidney injury, conversion to peritoneal dialysis, or kidney transplantation.During the 16-year follow-up, the number of hemodialysis patients in Korea has steadily increased from 11,215 in 2002 to 67,486 in 2017. The mean age of these patients has gradually increased from 55.57 ± 13.31 years in 2002 to 62.13 ± 13.23 years in 2017. In 2017, the crude prevalence rate of hemodialysis was 1303.4 per million population. Overall, the number of men tended to be somewhat higher than that of women, and the proportion of men increased slightly from 55.56% in 2002 to 58.45% in 2017. The proportion of diabetic patients increased rapidly from 23.84% to 47.84%, and the percentage of dyslipidemic patients rose from 18.9% to 86.7%. The number of incident hemodialysis patients increased significantly from 4406 in 2003 to 12,134 in 2014, and then decreased to 8090 in 2017. In the incident cases of hemodialysis, the observed increase in the proportion of male patients and in diabetes and dyslipidemia were similar to that of prevalent patients. The more recent era of hemodialysis initiation, the better 5-year survival rates were observed.The prevalence and incidence of hemodialysis in Korea gradually increased between 2002 and 2017. The proportion of men, and patients with diabetes and dyslipidemia requiring hemodialysis also increased continuously. The survival rate of hemodialysis patients was gradually improving. These findings may serve as a reference for future epidemiological studies on hemodialysis in Korea.

P1534EFFECT OF HIGH-FLUX DIALYZER MEMBRANE SURFACE AREA ON SURVIVAL IN CHRONIC HEMODIALYSIS PATIENTS

Abstract Background and Aims High-flux dialyzer membrane material has been shown to improve mortality in hemodialysis (HD) patients. However, little is known about the impact of surface area of dialyzer membrane on prognosis in HD patients. A retrospective analysis was undertaken to investigate whether the difference in high-flux dialyzer membrane area affects survival rate. Method We observed 119 patients (43 females, mean age; 68 years, and HD duration; mean 84.4 months) maintained on HD for up to 5 years and 7 months. All patients were divided into two groups according to the surface area of dialyzer membranes; S group, 39 patients treated with the dialyzer membrane area of &amp;lt;1.5m2 (mean 1.0±0.1 m2) and L group, 80 patients treated with that of ≥1.5m2 (mean 2.0±0.2 m2). We analysed survival rate by Kaplan-Meier method. Results The patients were treated with four types of high-flux dialyzer membranes. S group included 21 patients with cellulose triacetate (CTA), 17 patients with polysulfone (PS) and 1 patient with polymethylmethacrylate. L group included 2 patients with CTA, 71 patients with PS and 7 patients with polyethersulfone (PES). Thirty-two patients, including 12 patients in S group and 20 patients in L group, had diabetes mellitus (DM). Survival rate was compared between the two groups, patients treated with CTA, PS and PES, and those with and without DM by Kaplan-Meier method. Type of dialyzer membranes used did not affect survival rate at the final observation (65.2% in CTA, 75% in PES and 50% in PS, p=0.26). The surface area of dialyzer membrane did not have a significant impact on mortality; survival rate at 3-year for S group, 71% vs L group, 77%, at 5-year for S group, 51% vs L group, 59%, and at the final observation for S group, 48%, vs L group, 58% (p=0.352). Among 32 diabetic patients, survival rate at the final observation did not differ between the two groups (S group, 33%, vs L groups, 45%, p=0.477). Among 87 non-diabetic patients (S groups; 27 patients), survival rate did not differ between the two groups at the final observation (S group, 56%, vs L group, 63%, p=0.575). Conclusion We conclude that difference in high-flux dialyzer membrane area is unlikely to affect survival rate in HD patients.

P1504RELATIONSHIP OF LOW BODY MASS INDEX AND SURVIVAL IN HEMODIALYSIS PATIENTS

Abstract Background and Aims Malnutrition is common in patients with hemodialysis and major risk factor of mortality. The Korean Society of Nephrology (KSN) collected data of end-stage renal disease registry since 1985. We evaluated whether body mass index (BMI) can affect mortality in patient with hemodialysis. Method From 2004 to 2015, a total of 32,163 patients starting hemodialysis were included. The patients were divide four groups according quartiles of BMI measurement. Results At baseline, mean age was 59.0 ± 14.3 years old, and 60.0% were men. The 5-year mortality of hemodialysis patients was 16.9 % (N=5,435) and ratio of unknown state was 24.9 % (N=7,996). The mean of BMI in each quartiles were 18.2 ± 1.2, 20.8 ± 0.5 22.8 ± 0.6, 26.4 ± 2.6 kg/m2 respectively. The mean of BMI between survivor and non-survivor were different (22.3 ± 3.3 vs. 21.5 ± 3.2 kg/m2). Cox-proportional regression multivariate analysis revealed that the 5-year all-cause mortality was associated with age (HR 1.04, CI 1.03-1.05), diabetes (HR 1.34, CI 1.07-1.7) coronary heart disease or heart failure (HR 1.3, CI 0.9-1.7), 2nd BMI quartile (HR 0.7, CI 0.5-0.9), 3rd BMI quartile (HR 0.6, CI 0.46-0.88), 4th BMI quartile (HR 0.59, CI 0.43-0.82), hypoalbuminemia (HR 2.9, CI 2.3-3.7) and anemia (HR 1.6, CI 1.2-2.0) . Conclusion Higher quartiles of BMI was significantly associated with better survival rate in hemodialysis patients in Korea. Traditional risk factors of malnutrition, such as hypoalbuminemia, anemia were also independent risk factor for mortality. This result suggests that hemodialysis patients needed to nutritional support.

P1221THE VOXEL-BASED SPECIFIC REGIONAL ANALYSIS SYSTEM FOR ALZHEIMER’S DISEASE (VSRAD) BY MAGNETIC RESONANCE IMAGING SCAN IN PERITONEAL DIALYSIS (PD) PATIENTS, COMPARED WITH HEMODIALYSIS (HD) PATIENTS WITH ALZHEIMER’S DISEASE

Abstract Background and Aims Japan is currently moving towards an unprecedented aging society and chronic dialysis patients as well. As Aging population increases, in chronic dialysis patients as well, Mild cognitive impairment (MCI) and dementia cases are on the rise, and increasing burden on existing dialysis facilities. Our hospital has not only the outpatient department of Internal medicine, but also peritoneal and hemodialysis facilities, and Regional Dementia Center. We have accepted chronic dialysis patients, in our medical center and elderly ward, who are usually unable to maintain hospitalization or outpatient maintenance dialysis with cognitive impairment by collaborating with psychiatrists. Rehabilitation was instructed in all the patients by physiotherapists for the purpose of improving ADL. We investigated the current status of our PD patients, HD patients who experienced PD, and HD patients with Alzheimer’s type dementia (AZ). Method A: Nine cases of hemodialysis (HD), who subsided peritoneal dialysis (PD), (including 2 DM cases:22%), Average age 75.4± 9.1 years old, 4 males, 5 females; average dialysis duration 322± 126 M:(HD-PD). B: Thirteen cases of PD, (including DM 3 cases: 23%), 6 males, 7 females; average age 71.6± 10.9 years old, average dialysis duration 286± 139 M:(PD). C: Fifteen cases of hemodialysis (HD) who was diagnosed as AZ (including 8 DM cases: 53%), Average age 76.6± 8.5 years old, 9 males, 6 females; average dialysis duration 53.9± 66.1 M:(HD-AD). We examined blood pressure (BP), and laboratory data. Analysis of the body fluid status; extracellular water/ total body water (ECW/TBW; IN BODYR), Skeletal muscle index (SMI) was performed. Average Z-score points of MRI (assessment of hippocampus atrophy evaluation) and total brain atrophy was investigated by VSRAD. Results About 13 PD and 9 HD who experienced PD cases, there were 4 MCI cases, and no Alzheimer type dementia, or cerebrovascular dementia. About PD cases, average Hasegawa’s formula expression average (HDS-R): 28.8±1.8, average BMI: 22.3± 2.9, average skeletal muscle mass index (SMI): 6.6± 1.0 kg/m2, average Lipid ratio (%): 24.3± 7.8, average Z-score points of MRI : 1.02± 0.5 and total Brain atrophy was 4.3± 2.7 %. About HD-PD cases, one case had slight cerebrovascular dementia, and 2 cases are MCI; average Z-score was 1.2± 1.0 total Brain atrophy was 3.8± 1.4 %. Average SMI: 5.9± 1.3 kg/m2, average BMI:20.7± 3.8, average Lipid ratio (%): 21.9± 8.1. Two cases died of malnutrition and sepsis. About 15 HD patients with Alzheimer type (AZ-type) dementia, average HDS-R: 10.4± 9.3, average BMI: 18.9± 2.2, average SMI: 4.7± 1.0 kg/m2, average Lipid ratio (%): 23.5± 6.1, average Z-score points of MRI: 2.6± 0.9 and total Brain atrophy was 9.3± 5.7 %. One-year survival rate of HD patients with AZ was about 20% after transferring to our hospital. The data of SMI and LP% was relatively reserved in PD and HD-PD, but significantly low from that of HD-AZ, and therefore it might not be effective in rehabilitation because of muscle weakness in HD-AZ. There were almost no HD cases with overhydration (ECW/TBW). Almost all dialysis patients had simple some old cerebral infarctions by simple CT examination. Conclusion By CT and MRI image findings, almost PD cases had old low-density area in CT and no acute cerebral infarctions in MRI. The hippocampal atrophy and total brain atrophy of PD and HD-PD was extremely mild, but was very severe in HD-AZ. There were no cases with severe cognitive impairment between PD and HD-PD even if undergoing for over ten years.

MON-151 THE CURRENT STATUS AND PROGNOSIS OF AGED CHRONIC RENAL PERITONEAL AND HEMODIALYSIS PATEINTS WITH COGNITIVE IMPAIRMENTS

Japan is currently moving towards an unprecedented aging society among advanced countries and chronic dialysis patients as well. With aging, psychiatric problems and dementia cases are on the rise, and increasing burden on existing facilities. Our hospital has not only the outpatient department of Internal medicine, but also peritoneal (PD) and hemodialysis (HD) facilities, and Regional Dementia Center. We have accepted chronic dialysis patients, in our medical center and elderly ward, by collaborating with psychiatrists, who are usually unable to maintain hospitalization or outpatient maintenance dialysis unit in other hospitals. Meanwhile we could review the current situation, clarify the current problems and improve so that we can offer more useful medical care in the future. We examined about the clinical findings in our seventeen HD and theirteen PD patients, by MRI, CT, laboratory data, and analysis of the body fluid status, skeletal muscle, lipid; (IN BODYR) was performed. The 17 HD cases (including 8 DM), had the average age: 75.0 ± 8.8 years old, 9 males, 8 females, and mean their dialysis duration was 136 ± 164 months. They were all unmanageable in other hospitals or clinics.The 13 PD cases (including 6 DM), had the average age: 79.9 ± 7.6 years old,10 males, 3 females and mean their dialysis duration was 179± 92 months. About 17 HD cases; there were 11 cases of Alzheimer type dementia, 4 cases of cerebrovascular dementia, and 2 others; mean Hasegawa’s formula expression: 11.5± 8.8, mean BMI: 19.4± 2.2, mean skeletal muscle mass index (SMI): 4.76± 0.9 kg/m2, mean Lipid ratio (%): 23.4± 5.6, mean Z-score points of MRI (assessment of hippocampus atrophy): 2.7± 0.9. Five HD patients with dementia died of asipiration pneumonia and sepsis. About 13 PD cases, there were 5 cases of borderline cerebrovascular dementia, and 8 cases of no dementia; mean Z-score is 0.974± 0.26、mean SMI:6.43± 0.6, mean BMI:22.4± 2.8, mean Lipid ratio: 23.8± 9.6 %. Almost all dialysis patients had several old cerebral infarctions by simple CT examination. Four PD patients changed to HD, because of peritoneal sclerosis, massive pleural effusion, the gangrene of lower limbs and malnutrition. Two PD patients died of sepsis and respiratory failure. Rehabilitation was instructed in all the patients by physiotherapists for the purpose of improving ADL. The 5-year patient survival rate was 58% in HD, and 90% in PD patients. But one-year-patient survival rate of HD patients was about 20% after transferring to our hospital. In our HD patients with dementia, by CT and MRI image findings, there were the special characteristic findings with both Alzheimer-type dementia and cerebrovascular dementia. The hippocampal atrophy of our PD patients was significantly mild as compared with that of HD. There were no obvious dementia cases in PD although 92% of PD patients were over 70 years old and 61 % of PD were over 5-year PD continuation.

Comparison of 3‐year clinical outcomes after endovascular therapy for aortoiliac artery occlusive disease between patients with and without hemodialysis: Subanalysis of the REAL‐AI registry

The impact of hemodialysis (HD) on aortoiliac (AI) occlusive lesions remains unknown. Here, we report the 3-year clinical outcomes of endovascular treatment (EVT) for AI occlusive lesions in propensity-matched populations of patients who did and did not undergo HD. The cohort of this large-scale, multicenter, retrospective registry study included 574 consecutive patients with AI occlusive disease. Propensity score-matched analysis was performed to compare AI occlusive lesions between patients who did and did not undergo HD. The endpoints were primary patency, assisted primary patency, and secondary patency as well as overall survival and major adverse limb events (MALEs). A total of 57 matched pairs of patients who did and did not undergo HD were analyzed after propensity score-matched analysis. No significant difference was observed in primary patency, assisted primary patency, secondary patency, and MALEs at 3 years. The survival rate was significantly lower in the HD group than in the without-HD group (68% vs. 93%, P = 0.03). Although the survival rate of HD patients was poor, the results of EVT for AI occlusive lesions were reasonable in these patients.

Survival Rate and Predictors of Mortality among Hemodialysis Patients in West of Iran, 1996-2015.

Background:Hemodialysis (HD) is one of the treatments provided to end-stage renal disease (ESRD) patients. A few studies have investigated the survival rate of HD patients in Iran. Hence, we decided to investigate the survival rate and it is predictors among Iranian ESRD patients.Methods:This is a retrospective cohort study conducted in 165 HD patients in Tuyserkan city (Hamadan province) during 20 years from 1996 to 2015. The checklist used to gather information was comprised of patients’ demographic and clinical information. The analysis was performed using Kaplan–Meier curves, log-rank test, and cox regression model.Results:The most prevalent cause of ESRD was reported to be high blood pressure (32.7%). The probability of survival rate at the end of 1st, 5th, and 10th year was 0.65, 0.16, and 0.05, respectively. Results of multivariate cox regression showed that old age, catheter vascular access, and high hemoglobin level have a negative significant effect on survival of HD patients (P < 0.05).Conclusions:Overall, the survival of HD patients seems to be low in Tuyserkan as compared to other studies. Age, ESRD cause, vascular access, marital status, and hemoglobin level among other factors are proved to have a significant effect on survival probability.

Overhydration measured by bioimpedance analysis and the survival of patients on maintenance hemodialysis: a single-center study

BackgroundBioimpedance analysis (BIA) helps measuring the constituents of the body noninvasively. Prior studies suggest that BIA-guided fluid assessment helps to predict survival in dialysis patients. We aimed to evaluate the clinical usefulness of BIA for predicting the survival rate of hemodialysis patients in Korea. MethodsWe conducted a single-center retrospective study. All patients were diagnosed with end-stage renal disorder and started maintenance hemodialysis between June 2009 and April 2014. BIA was performed within the 1st week from the start of hemodialysis. The patients were classified into 2 groups based on volume status measured by the body composition monitor (BCM; Fresenius): an overhydrated group [OG; overhydration/extracellular water (OH/ECW) >15%] and a nonoverhydrated group (NOG; OH/ECW ≤15%). ResultsA total of 344 patients met the inclusion criteria. Of these, 252 patients (73.3%) were categorized into the OG and 92 patients (26.7%) into the NOG. Age- and sex-matching patients were selected with a rate of 2:1. Finally, 160 overhydrated patients and 80 nonoverhydrated patients were analyzed. Initial levels of hemoglobin and serum albumin were significantly lower in the OG. During follow-up, 43 patients from the OG and 7 patients from the NOG died (median follow-up duration, 24.0 months). The multivariate-adjusted all-cause mortality was significantly increased in the OG (odds ratio, 2.569; P = 0.033) and older patients (odds ratio, 1.072/y; P < 0.001). No significant difference of all-cause or disease-specific admission rate was observed between the 2 groups. ConclusionThe ratio of OH/ECW volume measured with body composition monitor is related to the overall survival of end-stage renal disorder patients who started maintenance hemodialysis.

Predicting the outcome of renal transplantation

Renal transplantation has dramatically improved the survival rate of hemodialysis patients. However, with a growing proportion of marginal organs and improved immunosuppression, it is necessary to verify that the established allocation system, mostly based on human leukocyte antigen matching, still meets today's needs. The authors turn to machine-learning techniques to predict, from donor-recipient data, the estimated glomerular filtration rate (eGFR) of the recipient 1 year after transplantation. The patient's eGFR was predicted using donor-recipient characteristics available at the time of transplantation. Donors' data were obtained from Eurotransplant's database, while recipients' details were retrieved from Charité Campus Virchow-Klinikum's database. A total of 707 renal transplantations from cadaveric donors were included. Two separate datasets were created, taking features with <10% missing values for one and <50% missing values for the other. Four established regressors were run on both datasets, with and without feature selection. The authors obtained a Pearson correlation coefficient between predicted and real eGFR (COR) of 0.48. The best model for the dataset was a Gaussian support vector machine with recursive feature elimination on the more inclusive dataset. All results are available at http://transplant.molgen.mpg.de/. For now, missing values in the data must be predicted and filled in. The performance is not as high as hoped, but the dataset seems to be the main cause. Predicting the outcome is possible with the dataset at hand (COR=0.48). Valuable features include age and creatinine levels of the donor, as well as sex and weight of the recipient.

Effects of increasing dialysis dose on serum albumin and mortality in hemodialysis patients

Dialysis dose and malnutrition have a great impact on the clinical outcome of chronic hemodialysis patients. The interrelationships between them, however, remain undefined. Thus, we performed a study to determine the effects of increasing the dialysis dose on serum albumin concentrations and mortality in hemodialysis patients. We examined urea kinetic modeling, biochemical nutritional indices, comorbid conditions, patient survival time, and annual mortality rate. Dialysis dose, measured by Kt/V, significantly increased from 1.3 ± 0.3 in 1987 to 1.5 ± 0.4 in 1990 and to 1.7 ± 0.4 in 1993. Serum albumin level also increased, from 3.8 ± 0.4 g/dL in 1987 to 4.0 ±0.4 g/dL in 1990 and to 4.3 ± 0.3 g/dL in 1993. In 1993, 76% of patients had Kt/V ≥1.50 compared with 45% in 1990 and 28% in 1987, whereas 82% of patients had a serum albumin level ≥4.0 g/dL in 1993 compared with 58% in 1990 and 29% in 1987. Protein catabolic rate and hematocrit also increased from 1987 to 1993, but not serum cholesterol or triglyceride. The annual mortality rate decline from 16.1% in 1987 to 13.2% in 1990 and to 8.0% in 1993. The decrease in mortality appeared to be unrelated to differences in patient selection or comorbid conditions. Serum albumin levels, hematocrit, Kt/V, and protein catabolic rate were significantly related to patient survival after age, sex, and diabetic status had been adjusted. Furthermore, there was a positive correlation between Kt/Vs and serum albumin concentrations ( r = 0.216, P <0.001). Thus, it appears that increasing the dose of dialysis improves serum albumin levels and perhaps survival rate in hemodialysis patients as well.