Characteristics of Patients on Hemodialysis Therapy for More Than 30 Years

Abstract

Since its experimental introduction in 1960, hemodialysis has become a widely performed and relatively safe procedure. Therapeutic strategies have been developed, and the numbers of long-term survivors of hemodialysis therapy have been increasing. Hemodialysis therapy was introduced at Sangenjaya Hospital in October 1970, and the 16 patients who have survived for more than 30 years on hemodialysis therapy since its introduction at the hospital were enrolled in this study to investigate the characteristics of long-term hemodialysis patients. For comparison, 50 patients on hemodialysis for less than 30 years were also studied (21 patients with <10 years hemodialysis, 13 with 10-20 years hemodialysis and 16 with 20-30 years hemodialysis). Background information (age, gender, and cause of renal disease), dialysis dose (single pool [sp.] Kt/V), mineral metabolism (serum phosphate), anemia management (serum hemoglobin), and nutrition (serum albumin and reduced interdialytic weight gain) were assessed. Hemodialysis was instituted at 28.7 +/- 6.4 years of age. The primary cause of end-stage renal disease was chronic glomerulonephritis in all of the patients except one, and in that patient it was polycystic kidney disease. As an index of the dialysis dose, sp. Kt/V was 1.2 +/- 0.11. As an index of mineral metabolism, serum phosphate was 5.4 +/- 0.9 mg/dL. As an index of anemia management, serum hemoglobin was 10.2 +/- 1.2 g/dL. As indexes of nutrition, serum albumin was 4.0 +/- 0.2 g/dL and interdialytic weight gain was 4.43 +/- 1.36%. The sp. Kt/V-value, serum phosphate, serum hemoglobin and interdialytic weight gain did not differ between the four different hemodialysis duration groups. Serum albumin was lower in the >30 group (4.0 +/- 0.2 g/dL) than in the <10 group (4.2 +/- 0.3 g/dL) (P = 0.046). As the duration of hemodialysis has increased, the age at hemodialysis induction has become younger. The cause of the renal failure was chronic glomerulonephritis in most of the cases. None had diabetic nephropathy. Improvement of the prognosis of patients with diabetic nephropathy is required. Most of the indexes of these patients nearly satisfied the recommended values.

Long-term haemodialysis survival

“…Kurkus et al [3] described two patients who had been dialysed for 35 years, interrupted by short transplant periods. Other series describe patients with shorter survival [4–8]. Factors associated with long survival are young age at start, normotension and absence of diabetes.…”

Long-Term Survival of Patients with IgA Nephropathy After Dialysis Therapy

“…Firstly, such patients usually start dialysis at an earlier age than those who need dialysis for other reasons. Some observational studies have pointed out that starting dialysis younger is an important factor in surviving for up to 30 years [11,12]. In fact, the annual report of the JSDT registry (2008) states that the mean age of the entire dialysis patient population at that time was 65.3 years [5], whereas the mean age of the patients with IgAN in this study who started dialysis was 42.8 years.…”

Characteristics of Body Composition and Nutritional Status in Patients Receiving Hemodialysis Therapy for More than 30 Years

“…The Student t test was used for comparisons between continuous variables. The 2 or Fisher exact probability test was applied for categorical data. Multiple regression analysis and stepwise regression analysis was used to determine the contribution of various factors to corrected AMA.…”

“…Therefore, Japan provides an ideal setting for describing patients receiving extremely longterm dialysis. We have previously reported various indexes affecting mortality in patients who have received hemodialysis for more than 30 years [2] . On the other hand, patients with advanced CKD, especially those on long-term dialysis, often suffer from muscle wasting [3] .…”