Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis

Abstract

BackgroundDialysis frequency and dose are controversial prognostic factors of hemodialysis morbidity and mortality. The aim of this study was to find out the effect of frequency and dosage of dialysis on mortality and survival in a group of Chinese hemodialysis patients.Material/MethodsIn total, 183 patients seen from February 2008 to January 2018, who were on maintenance hemodialysis for at least 3 months, were included in the study cohort. An anonymized database of age, gender, diabetic status, comorbidities, date of initiation of dialysis, hematological characters, biochemical variables, and status of survived or died was established from DICOM (Digital Imaging and Communications in Medicine) files of patients. Kaplan-Meier and Cox-proportional hazard model was used for calculation of survival over time at 95% confidence level.ResultsOverall, the 10-year survival rate was 27%. Kaplan-Meier analysis showed patient survival as 94% at one-year, 59% at 5-years, and 27% at 10-years. Hemoglobin, serum albumin, calcium, potassium, phosphorous, calcium-phosphorous-products, and hemodialysis frequency and the dose had a significant effect on survival. Cox regression proportional hazard model showed that patients with serum albumin level of >4 g/dL were better associated with survival. Patients who underwent twice-weekly hemodialysis had 4.26 times less chance of survival as compared to patients with thrice-weekly hemodialysis. A higher dialysis dose of >1.2 spKt/V offered better survival as compared to a lower dose of <1.2 spKt/V.ConclusionsHypoalbuminemia, hemodialysis time, and hemodialysis frequency were significantly associated with mortality.

Ten-year survival of patients treated with peritoneal dialysis: A prospective observational cohort study

“…Among hemodialysis patients, the proportion of patients surviving at 10 years was found to be 25-27%. 6,7 It seemed that long-term outcomes were comparable between hemodialysis and PD therapy. Much better patient survival was observed in a small study by Tiranathanagul et al 8 with 5-year and 10-year survival rates at 77.7% and 61.8%, respectively, for patients performed with high-efficiency online hemodiafiltration.…”

“…6 The 10-year survival rate was 27% in a Chinese hemodialysis center of 183 participates, while it was 61.8% in 66 patients treated with high-efficiency online hemodiafiltration in South East Asia. 7,8 Previous limited studies were all about hemodialysis patients, and the 10-year patient survival rates of PD patients were poorly known or dated. Furthermore, little was documented about the long-term technique survival in patients treated with PD.…”

Is twice-weekly maintenance hemodialysis justified?

“…The survival rate of 81.81% at 2 years is comparable to thrice-weekly hemodialysis and in a developing country is an acceptable outcome. [ 20 ] The mortality was 7% in the first year and 9% in the second year. The commonest causes of mortality were cardiovascular diseases and sepsis, both of which are reversible and treatable.…”

Vascular access and survival of patients with hemodialysis: features of cause-effect relationship

“…волемического статуса и др. [4][5][6][7]. Более того, ряд факторов (например, пол, возраст, наличие сахарного диабета) также частично ограничивают возможности создания устойчивого сосудистого доступа и могут существенно повлиять на подходы к обеспечению больных оптимальным доступом [8,9].…”