Predictive Factors of One-Year Mortality in a Cohort of Patients Undergoing Urgent-Start Hemodialysis

Abstract

BackgroundChronic kidney disease (CKD) affects 10–15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality.Patients and methodsWe studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD) and mineral and bone disease associated with CKD (CKD-MBD), and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis.ResultsThe patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%). Major risk factors were smoking (19.6%), dyslipidemia (48.8%), and CVD (41%). Upon admission, most patients had no vascular access for hemodialysis (89.4%). Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%). These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D.ConclusionsThe combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population.

The metabolomic quest for a biomarker in chronic kidney disease

“…Changes in amino acid metabolism are widely seen in those with CKD and on dialysis [ 9 , 10 , 17 , 52 , 53 ] but whether this is due to CKD progression, other diseases or concomitant with poor nutritional status and dietary protein intake remains elusive, compounded by the fact that very few studies that include an assessment of nutritional status or dietary intake. Diet is an important factor that should be assessed as those who display malnutrition and protein-energy malnutrition have worse outcomes and early mortality in CKD and on dialysis [ 54–56 ]. Utilizing a subjective global assessment (SGA) tool will enable the clinician and researcher to understand and appreciate whether the metabolites identified result from nutritional status, dietary intake or from disease [ 57–59 ].…”

Dialysis Start Timing: Development and Validation of Start Scoring Scale

“…В качестве критерия экстренного начала диализа мы использовали отсут-ствие времени для создания постоянного сосудистого доступа и других мер подготовки к диализу (улучшить доступную консервативным мерам коррекцию анемии, артериального давления, водно-электролитного балан-са). В некоторых исследованиях понятие экстренного старта определяется по длительности предшество-вавшего старту наблюдения у нефролога (например, три месяца), в то время как в других исследованиях экстренный старт определялся по началу диализа в течение 24 часов от поступления [23].…”

Arteriovenous fistula for dialysis — what do we know today?

“…The conditions to create a well-functioning fistula are optimal timing of vascular access surgery, selection of the best blood vessels and appropriate use and care of the AVF [3,8]. According to European recommendations, AVF should be created at stage 4 CKD, i.e.…”

“…The overall prevalence of CKD increases with age which is in itself a challenge in the context of the world's population growth and aging. The prevalence of CKD in the Polish population over the age of 65 is 29.4% [1][2][3].…”

“…Nearly 1.9 million people worldwide underwent dialysis in the year 2010 [3]. Also, more patients require long-term renal replacement therapy.…”