腎臓学と治療学ジャーナル

Factors Associated with Mortality of Patients on Hemodialysis

Abstract

Jorge Coronado*,Benito Balmaceda,Amaury Ariza,Enrique Ramos,Cindy Mestra,Stephany Montenegro

Introduction: End-stage renal disease is associated with a high annual rate of cardiovascular disease mortality. To this date, there is no local research regarding this topic. Objective: To identify risk factors associated with mortality in prevalent chronic dialysis patients. Methods: A case-control study was conducted in 2011-2012, in the city of Cartagena, Colombia. Deceased adult patients were included in the period. Those with advanced cancer, AIDS, liver cirrhosis, Child-Pugh C or patients with incomplete records were excluded. For each case two controls matched by age, sex and dialysis shift were selected. The clinical records were reviewed to consider social and demographic data, comorbidities, clinical and paraclinical variables. Statistical analysis was performed using Chi square, Student t-Test, Mann-Whitney and Multivariate Logistic Regression Analysis. Findings: This study chose 85 cases from 109 deceased patients and 170 controls were chosen. No statistically significant differences were found among the patients treated under the Social Security System with regards to Comorbidities, Cause of ESRD, Pre-dialysis Blood Pressure, Hemoglobin, Kt/V, Calcium, Phosphorus, Triglycerides, Ferritin and intact parathyroid hormone (PTH) levels. Causal associations found for time variables in hemodialysis of less than one year include vascular access via catheter, anemia, total cholesterol, underweight and hypoalbuminemia. These were more frequently found in cases studied when compared to the controls. Multivariate logistic regression analysis showed that the factors associated with mortality were related to underweight (odds ratio [OR], 2.64; 95% Confidence interval [CI], 1.04 to 6.70) and to hypoalbuminemia (OR, 3.0; 95% CI, 1.21 to 7.43). Traditional risk factors did not show any causal association. Conclusion: The case control study showed that underweight and hypoalbuminemia have a statistically significant causal relationship with the factors associated with mortality on hemodialysis patients.