Predialysis management and predictors for early mortality in uremic patients who die within one year after initiation of dialysis therapy

Abstract

Despite improvements in dialysis therapy, the mortality rate of patients with end stage renal disease (ESRD) has remained high. A relatively high proportion of uremic patients dies within one year after the initiation of dialysis treatment. The aim of this study was to evaluate predictors for this early mortality in patients with ESRD. A total of 66 uremic patients were included in the study. Patients were divided in those who survived < 1 year (n = 17) and those who survived ≥ 1 year (n = 49). We compared the prevalence of diabetes and hypertension and of vascular diseases as well as the prevalence of heart insufficiency (EF < 30%) and left ventricular hypertrophy (LVH). Additionally, we estimated the laboratory parameters serum creatinine, creatinine clearance, BUN, cholesterol, triglycerides, fibrinogen, serum protein, serum albumin and hemoglobin, and evaluated the indications for the initiation of dialysis therapy in both patient groups. The patients with survival < 1 year were significantly older (64 ± 12 vs. 54 ± 14 years, p < 0.01) and showed a lower BMI (22 ± 3 vs. 25 ± 3, p < 0.01) than those who survived > 1 year. The prevalence of diabetes (70% vs. 31%, p < 0.05), cardiac insufficiency (70% vs. 16%, p < 0.025), cardiovascular disease (65% vs. 28%, p < 0.05) and peripheral vascular diseases (70% vs. 28%, p < 0.05) was significantly higher in the patients with early mortality. The prevalence of hypertension was similar in both groups, however, the prevalence of LVH was significantly higher in the patients who survived < 1 year (88% vs. 37%, p < 0.05). Laboratory parameters were not significantly different in the two groups of patients, with the exception of serum albumin, which was significantly lower in the patients with early mortality (3.5 ± 0.6 vs. 3.9 ± 0.4 g/l, p < 0.02). Hyperhydration was the most common indication for the start of dialysis in patients with early mortality (59% vs. 13%, p < 0.025). Cardiac insufficiency was the most common cause of death in these subjects (n = 10, 59%). Six individuals (12%) died within four weeks after initiating dialysis therapy. Thus, there are several predictors for early mortality in end-stage renal disease patients, including high age, low BMI, the presence of diabetes, coronary heart disease, heart insufficiency and LVH, as well as low serum albumin levels. A relatively high percentage of patients die shortly after the start of dialysis therapy. Heart insufficiency is the most common cause of early death in these patients.