Mortality Risk Factors in Patients Treated by Chronic Hemodialysis

Abstract

A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values < 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather than three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index ( < 20 kg/m²), low cholesterol ( < 4.5 mmol/l) and low mean predialysis blood urea ( < 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.

Weekly Averaged Blood Pressure Is More Important than a Single-Point Blood Pressure Measurement in the Risk Stratification of Dialysis Patients

“…That there was no (23) found that low DBP was associated with a higher death rate and cardiovascular mortality. Degoulet et al (24) showed an association between both SBP and DBP and cardiovascular mortality in 1453 prospectively studied HD patients. Conversely, it was reported that no significant difference was found between the survival rates of 168 normotensive and 202 hypertensive patients (7).…”

The Obesity Paradox and Mortality Associated With Surrogates of Body Size and Muscle Mass in Patients Receiving Hemodialysis

“…34,35 In contrast to trends seen in the general population, higher BMI has generally not been associated with an increase in mortality rate in patients receiving HD. [36][37][38][39][40][41] Johansen et al 40 reported that body fat and muscle mass, surrogates of body size, were both associated with improved survival in obese patients receiving HD, whereas Beddhu et al 42 showed that urinary creatinine level as a surrogate of muscle mass has a stronger association with survival than does body fat. 39,43 Only a very few studies have failed to confirm the survival advantages of obesity in patients with CKD.…”

Nutritional status of hemodialysis patients with secondary hyperparathyroidism

“…Several markers of malnutrition such as low body mass index and low serum albumin have been associated with high morbidity and mortality rates in this group of patients (3,4). Malnutrition in these patients is considered to be due to anorexia with low food intake (5)(6)(7), to the loss of nutrients and catabolism during the dialysis procedure (8,9), intercurrent illnesses (10), metabolic L.T.T.…”