Survival as an index of adequacy of dialysis

Abstract

To examine how patient survival substantiates dialysis adequacy, 20-year actuarial survival experience was calculated for 445 unselected hemodialysis (HD) patients (97 patients accepted on a temporary basis--and usually kept on their regular dialysis scheme--were left out). The dose of dialysis has been the same and unchanged for all patients since beginning: 24 square meter hours of Kiil dialysis (cuprophane) per week with acetate buffered dialysate. KT/V mean (SD) was 1.67 (0.41). Six months after starting dialysis, 98% of patients were normotensive and off all blood pressure (BP) medication. The mean population hematocrit, excluding the only 6 patients receiving erythropoietin supplementation, was 28%. Survival rate was 87% at 5 years, 75% at 10 years, 55% at 15 years, and 43% at 20 years of HD. The satisfactory control of BP without using potentially toxic BP drugs and the higher than usual dose of dialysis are two possible explanations for survival data better than usually reported. We suggest that patient survival should be considered as the best overall index of adequacy of dialysis.

Predictors of long-term survival of hemodialysis patients in Hamadan province, west of Iran

“…The survival probability in 1st, 5th, and 10th years were 81%, 40%, and 13% This study showed that the 5-year survival of HD patients was 40%. This proportion was lower than that reported from France and Brazil with the 5 year survival equal 87% and 63.32% (21,22). However, the survival of our patients is more than that of the study conducted in Ethiopia by 14.8% (23).…”

Relative Contribution of Residual Renal Function and Different Measures of Adequacy to Survival in Hemodialysis Patients

“…However, an important drawback of the observational NECOSAD study is the restriction to treatment characteristics that are usually present in current dialysis practice. In the study of Charra et al (19,20) in Tassin, France, an excellent survival was reported for a group of HD patients who were treated with a very long duration of dialysis (8 hr/session in a thrice-weekly schedule), which resulted in a high eq-dKt/V urea of 1.6/session. The data from Tassin have been widely quoted to support the hypothesis that a longer treatment duration is associated with a better outcome as a result of a better removal of the uremic toxins with a larger molecular weight and a better fluid balance control.…”

Cardiovascular Problems on Hemodialysis

“…Observational studies in prevalent dialysis populations yielded controversial results: Low BP values were associated with the highest risk (17,94). Studies of patients who had less morbidity and were on long, slow dialysis clearly showed that low BP values within the normal range provided a survival benefit (16). The issue is very complex, and problems such as central versus peripheral BP, circadian BP profile, preexisting cardiovascular morbidity, and differential effect of antihypertensive agents on different endpoints have not been fully investigated.…”

“…There is no doubt that, at least in the long term, hypertension is a powerful predictor of mortality for patients who are on hemodialysis (16), despite that in patients with cardiovascular damage low BP rather than high BP is associated with higher mortality (17). In the first article ever on maintenance hemodialysis, Scribner, a prophet in the desert, stated (18): "In the case of dialysis patients a low normal level of ECV is maintained by the powerful tool of ultrafiltration which, if properly used along with moderate dietary sodium restriction and maintenance of natriuresis by diuretics (19), are the only proven method of controlling BP in the hemodialysis population."…”