Trends in mortality and comorbidities in hemodialysis patients between 2012 and 2017 in an East-European Country: a retrospective study

Abstract

Purpose The aim of this study was to evidence trends and changes in mortality, comorbid conditions, prognosis, and causes of death after 5 years of continuous evolution of hemodialysis (HD) patients in Romania. Methods We included two cohorts of stable HD patients (901 from 2012 and 1396 from 2017). Both cohorts were followed up for 1 year. The 5-year survivors of the 2012 cohort were identified in 2017 and their data changes were assessed. Results The 2017 patients were older, with longer time on dialysis, higher serum creatinine and urea levels, and required higher ultrafiltration volume per dialysis. They also had lower hemoglobin, lower C-reactive protein, higher albumin, higher calcium bicarbonate, and higher parathyroidectomy prevalence. The 2017 cohort presented with lower average dialysis flow, less administration of iron sucrose, had more catheters, lower hepatitis C prevalence, higher diabetes mellitus prevalence, higher heart valve calcifications, higher heart rate disorders, higher prevalence of left ventricular hypertrophy, and lower ejection fraction. Cardiovascular disease was the main cause of death in both years (50% in 2012 and 45.6% in 2017), followed by sepsis and cancer. The mortality was higher in 2017 compared to 2012 (14.1 vs 6.6%). The 5-year mortality was 37.2% with an average of 7.44%/year. The risk of death increased with age, higher C-reactive protein, higher phosphate, lower hemoglobin, and lower albumin. Conclusion Cardiovascular disease remains the main causes of death in HD-treated patients but with decreasing trend. Developing regional therapeutic strategies for quality care with early intervention will most likely improve mortality.

Hemodialysis dose and long-term COVID-19 outcomes – a retrospective cohort study

“…A notable proportion of HD patients contend with comorbidities, encompassing conditions such as hypertension, cardiovascular events, and diabetes. 38,39 In our study cohort, a higher prevalence of these concurrent health issues was observed in patients with Kt/V<1.4 compared to the group achieving the Kt/V target. This observation emphasizes that our study cohort is not an exception and higher comorbidity burdens were evident in patients with suboptimal dialysis doses.…”

Early Detection of Inflammation and Malnutrition and Prediction of Acute Events in Hemodialysis Patients through PINI (Prognostic Inflammatory and Nutritional Index)

“…The incidence of stroke was 22.22%, comparable to previous studies, reporting 25% [ 12 ]. In 2020, according to a study conducted by Chisavu et al, the mortality rate caused by cardiovascular diseases was reported as predominant, accounting for 53% of all cases [ 36 ]. Moreover, the primary cause of initiating hemodialysis among patients with a PINI over 1 is diabetic nephropathy (11 patients), which is also recognized as the predominant etiology of chronic kidney disease globally.…”

Risk prediction models for cardiovascular events in hemodialysis patients: A systematic review

“…In addition, it is advisable to continue investigating predictors of CV event risk in HD patients at different time stages to improve individualized prevention and treatment. Several studies 34,35 have highlighted that the epidemiological characteristics of HD patients who experience early CV events differ from those who experience such events at a later stage.…”