Journal of Shandong University (Health Sciences) ›› 2024, Vol. 62 ›› Issue (4): 48-53.doi: 10.6040/j.issn.1671-7554.0.2023.1106

• Clinical Medicine • Previous Articles     Next Articles

Risk factors for death within 2 years in new maintenance haemodialysis patients

LI Jian, SUN Yun   

  1. Department of Nephrology, Multidisciplinary Innovation Center for Nephrology, The Second Hospital, Cheeloo College of Medicine, Shandong University, Jinan 250033, Shandong, China
  • Published:2024-05-16

Abstract: Objective To explore the risk factors for death within 2 years in patients newly admitted to maintenance haemodialysis(MHD). Methods The 2-year clinical data of patients who started haemodialysis from March 2019 to November 2020 in The Second Hospital, Cheeloo College of Medicine, Shandong University were retrospectively collected. They were divided into death group and survival group according to whether they had died at 2 years. The clinical data were compared and the risk factors for death were analyzed. The patients were grouped by pre-dialysis systolic blood pressure(SBP)to compare the impact of blood pressure. Finally, the independent risk factors for patient death were analyzed using univarite and mnltivariate Cox regression models. Results During the observation period, a total of 83 patients were newly admitted to MHD, 4 left within 2 years, and 3 received renal transplant. Of the 76 cases included, 17(22.4%)died. Compared with the survival group, patients in the death group had lower blood potassium, albumin, blood creatinine, and SBP at baseline, a higher proportion of comorbid coronary artery disease and diabetes mellitus, and a higher estimated glomerular filtration rate; patients with an SBP ≤140 mmHg(1 mmHg=0.133 kPa)had a higher case-fatality rate. Cox regression analysis revealed that the lower pre-dialysis SBP(HR=0.957, 95%CI: 0.928-0.987), albumin(HR=0.918, 95%CI: 0.857-0.984), and comorbid diabetes mellitus(HR=3.690, 95%CI: 1.157-11.768)were found to be independent risk factors for death in patients(P<0.05). Conclusion Newly admitted MHD patients have a high case-fatality rate; SBP≤140 mmHg suggests higher risk of death; lower pre-dialysis SBP, albumin, and comorbid diabetes mellitus are risk factors for their death within 2 years.

Key words: Maintenance haemodialysis, Pre-dialysis blood pressure, Risk of death, Risk factors

CLC Number: 

  • R459.5
[1] Lv JC, Zhang LX. Prevalence and disease burden of chronic kidney disease[J]. Adv Exp Med Biol, 2019, 1165: 3-15.
[2] Wang LM, Xu X, Zhang M, et al. Prevalence of chronic kidney disease in China: results from the sixth China chronic disease and risk factor surveillance[J]. JAMA Intern Med, 2023, 183(4): 298-310.
[3] Cardoso A, Branco C, Sant’Ana M, et al. Hypoalbuminaemia and one-year mortality in haemodialysis patients with heart failure: a cohort analysis[J]. J Clin Med, 2021, 10(19): 4518.
[4] Ebrahimi V, Khademian MH, Masoumi SJ, et al. Factors influencing survival time of hemodialysis patients; time to event analysis using parametric models: a cohort study[J]. BMC Nephrol, 2019, 20(1): 215.
[5] Ferreira ES, Moreira TR, da Silva RG, et al. Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort[J]. BMC Nephrol, 2020, 21(1): 502.
[6] 程梁英, 付平, 周莉. 终末期肾病新入血液透析患者3个月内死亡危险因素分析[J]. 临床肾脏病杂志, 2019, 19(8): 598-604. CHENG Liangying, FU Ping, ZHOU Li. Risk factor analysis of death within the first 3 months of hemodialysis in patients with end stage nephropathy[J]. J Clin Nephol, 2019, 19(8): 598-604.
[7] 陈香美. 中国肾脏病学发展的现状与未来[J]. 中华医学信息导报, 2021, 36(5): 19.
[8] Lukowsky LR, Kheifets L, Arah OA, et al. Patterns and predictors of early mortality in incident hemodialysis patients: new insights[J]. Am J Nephrol, 2012, 35(6): 548-558.
[9] DAmico M, Locatelli F. Hypertension in dialysis: pathophysiology and treatment[J]. J Nephrol, 2002, 15(4): 438-445.
[10] Verbeke F, Lindley E, van Bortel L, et al. A European Renal Best Practice(ERBP)position statement on the Kidney Disease: improving Global Outcomes(KDIGO)clinical practice guideline for the management of blood pressure in non-dialysis-dependent chronic kidney disease: an endorsement with some caveats for real-life application[J]. Nephrol Dial Transplant, 2014, 29(3): 490-496.
[11] Sumida K, Molnar MZ, Potukuchi PK, et al. Blood pressure before initiation of maintenance dialysis and subsequent mortality[J]. Am J Kidney Dis, 2017, 70(2): 207-217.
[12] Chrysohoou C, Mantzouranis E, Dimitroglou Y, et al. Fluid and salt balance and the role of nutrition in heart failure[J]. Nutrients, 2022, 14(7): 1386.
[13] Vallianou NG, Mitesh S, Gkogkou A, et al. Chronic kidney disease and cardiovascular disease: is there any relationship?[J]. Curr Cardiol Rev, 2019, 15(1): 55-63.
[14] Kurasawa S, Yasuda Y, Kato S, et al. Relationship between the lower limit of systolic blood pressure target and kidney function decline in advanced chronic kidney disease: an instrumental variable analysis from the REACH-J CKD cohort study[J]. Hypertens Res, 2023, 46(11): 2478-2487.
[15] Mortazavi M, Adibi P, Hassanzadeh Keshteli A, et al. Comparison of gastrointestinal symptoms between patients undergoing hemodialysis and healthy population[J]. Middle East J Dig Dis, 2022, 14(3): 310-316.
[16] Chiang HP, Chiu YW, Lee JJ, et al. Blood pressure modifies outcomes in patients with stage 3 to 5 chronic kidney disease[J]. Kidney Int, 2020, 97(2): 402-413.
[17] Afsar B, Afsar RE, Ertuglu LA, et al. Nutrition, immunology, and kidney: looking beyond the horizons[J]. Curr Nutr Rep, 2022, 11(1): 69-81.
[18] Mantha Y, Asif A, Fath A, et al. Implications of kidney disease in patients with peripheral arterial disease and vascular calcification[J]. Interv Cardiol Clin, 2023, 12(4): 531-538.
[19] Maraj M, Ku snierz-Cabala B, Dumnicka P, et al. Malnutrition, inflammation, atherosclerosis syndrome(MIA)and diet recommendations among end-stage renal disease patients treated with maintenance hemodialysis[J]. Nutrients, 2018, 10(1): 69.
[20] Miller E, Raj D, Cavender MA, et al. Cardiorenal care coordination: holistic patient care opportunities in the primary care setting for patients with chronic kidney disease and atherosclerotic cardiovascular disease[J]. Postgrad Med, 2023, 135(7): 708-716.
[21] Danielski M, Ikizler TA, McMonagle E, et al. Linkage of hypoalbuminemia, inflammation, and oxidative stress in patients receiving maintenance hemodialysis therapy[J]. Am J Kidney Dis, 2003, 42(2): 286-294.
[22] Port FK, Pisoni RL, Bragg-Gresham JL, et al. DOPPS estimates of patient life years attributable to modifiable hemodialysis practices in the United States[J]. Blood Purif, 2004, 22(1): 175-180.
[23] Sridhar NR, Josyula S. Hypoalbuminemia in hemodialyzed end stage renal disease patients: risk factors and relationships: a 2 year single center study[J]. BMC Nephrol, 2013, 14: 242. doi:10.1186/1471-2369-14-242.
[24] Kato A, Takita T, Furuhashi M, et al. Comparison of serum albumin, C-reactive protein and carotid atherosclerosis as predictors of 10-year mortality in hemodialysis patients[J]. Hemodial Int, 2010, 14(2): 226-232.
[25] Rhee JJ, Zheng YC, Montez-Rath ME, et al. Associations of glycemic control with cardiovascular outcomes among US hemodialysis patients with diabetes mellitus[J]. J Am Heart Assoc, 2017, 6(6): e005581. doi:10.1161/JAHA.117.005581
[26] Sattar A, Argyropoulos C, Weissfeld L, et al. All-cause and cause-specific mortality associated with diabetes in prevalent hemodialysis patients[J]. BMC Nephrol, 2012, 13: 130. doi:10.1186/1471-2369-13-130
[27] Sanz París A, Lou Arnal LM, Gutiérrez Colón JA, et al. Diabetes in hemodialysis: study of differential factors[J]. An Med Interna, 1998, 15(4): 183-188.
[28] Mori K, Nishide K, Okuno S, et al. Impact of diabetes on sarcopenia and mortality in patients undergoing hemodialysis[J]. BMC Nephrol, 2019, 20(1): 105.
[29] Heaf J, Heiro M, Petersons A, et al. First-year mortality in incident dialysis patients: results of the Peridialysis study[J]. BMC Nephrol, 2022, 23(1): 229.
[30] Yeung WG, Palmer SC, Strippoli GFM, et al. Vitamin D therapy in adults with CKD: a systematic review and meta-analysis[J]. Am J Kidney Dis, 2023, 82(5): 543-558.
[31] Magagnoli L, Cozzolino M, Caskey FJ, et al. Association between CKD-MBD and mortality in older patients with advanced CKD-results from the EQUAL study[J]. Nephrol Dial Transplant, 2023, 38(11): 2562-2575.
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