Characteristics and predictors of mortality on haemodialysis in Brazil: a cohort of 5,081 incident patients

BMC Nephrology

Maria Eugenia F. Canziani¹  Ana Paula Roque-da-Silva²  Ana Beatriz Lesqueves Barra³  Jorge Paulo Strogoff-de-Matos⁴  Jocemir R. Lugon⁴ 

[1] Escola Paulista de Medicina, Universidade Federal de São Paulo, São Paulo, Brazil;Postgraduation Program in Medical Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil;Postgraduation Program in Medical Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil;Fresenius Medical Care Brazil, Rio de Janeiro, Brazil;Postgraduation Program in Medical Sciences, Universidade Federal Fluminense, Niterói, Rio de Janeiro, Brazil;Nephrology Division, Department of Medicine, Universidade Federal Fluminense, Av. Marquês do Paraná 303, 2 andar, Niterói, Zip Code 24033-900, Rio de Janeiro, Brazil;

关键词: End-stage renal disease;    Haemodialysis;    Epidemiology;    Survival analysis;    Brazil;   

DOI  :  10.1186/s12882-022-02705-x

来源: Springer

【 摘 要 】

BackgroundAlthough Brazil has one of the largest populations on haemodialysis (HD) in the world, data regarding patients’ characteristics and the variables associated with risk of death are scanty.MethodsThis is a retrospective analysis of all adult patients who initiated on maintenance HD at 23 dialysis centres in Brazil between 2012 and 2017. Patients were censored after 60 months of follow-up or at the end of 2019.ResultsA total of 5,081 patients were included in the analysis. The median age was 59 years, 59.4% were men, 37.5% had diabetes as the cause of kidney failure. Almost 70% had a central venous catheter (CVC) as the initial vascular access, about 60% started dialysis in the hospital, and fluid overload (FO) by bioimpedance assessment was seen in 45% of patients. The 60-month survival rate was 51.4%. In the Cox regression analysis, being older (P<0.0001), starting dialysis in the hospital (P=0.016), having diabetes as the cause of kidney failure (P=0.001), high alkaline phosphatase (P=0.005), CVC as first vascular access (P=0.023), and FO (P<0.0001) were associated with higher death risk, whereas higher body mass index (P=0.015), haemoglobin (P=0.004), transferrin saturation (P=0.002), and serum albumin (P<0.0001) were associated with better survival. The same variables, except initial CVC use (P=0.14), were associated with death risk in an analysis of subdistribution proportional hazards ratio including the competing outcomes.ConclusionsThe present study gives an overview of a large HD population in a developing country and identifies the main predictors of mortality, including some potentially modifiable ones, such as unplanned initiation of dialysis in the hospital and fluid overload.

【 授权许可】

CC BY