Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China.

Kang-kang Song; De-long Zhao; Yuan-da Wang; Yong Wang; Xue-feng Sun; Li-ning Miao; Zhao-hui NI; Hong-li Lin; Fu-you Liu; Ying LI; Ya-ni HE; Nian-song Wang; Cai-li Wang; Ai-hua Zhang; Meng-hua Chen; Xiao-ping Yang; Yue-yi Deng; Feng-min Shao; Shu-xia FU; Jing-ai Fang; Guang-yan Cai; Xiang-mei Chen

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Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China.

Author: Kang-Kang SONG ¹ ; De-Long ZHAO ¹ ; Yuan-Da WANG ¹ ; Yong WANG ¹ ; Xue-Feng SUN ¹ ; Li-Ning MIAO ² ; Zhao-Hui NI ³ ; Hong-Li LIN ⁴ ; Fu-You LIU ⁵ ; Ying LI ⁶ ; Ya-Ni HE ⁷ ; Nian-Song WANG ⁸ ; Cai-Li WANG ⁹ ; Ai-Hua ZHANG ¹⁰ ; Meng-Hua CHEN ¹¹ ; Xiao-Ping YANG ¹² ; Yue-Yi DENG ¹³ ; Feng-Min SHAO ¹⁴ ; Shu-Xia FU ¹⁵ ; Jing-Ai FANG ¹⁶ ; Guang-Yan CAI ¹ ; Xiang-Mei CHEN ¹
Author Information

1. Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
2. Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
3. Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center, Shanghai 200127, China.
4. Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
5. Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
6. Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, Hebei 050081, China.
7. Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
8. Department of Nephrology, Shanghai Jiao Tong University, Affiliated The Sixth People's Hospital, Shanghai 200233, China.
9. Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014040, China.
10. Department of Nephrology, Peking University Third Hospital, Beijing 100191, China.
11. Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
12. Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832008, China.
13. Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
14. Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China.
15. Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
16. Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
Publication Type:Journal Article
MeSH: Adult; Aged; China; Female; Humans; Male; Middle Aged; Multivariate Analysis; Renal Dialysis; adverse effects; mortality; Retrospective Studies; Risk Factors
From: Chinese Medical Journal 2017;130(8):885-891
CountryChina
Language:English
Abstract:
BACKGROUNDPatients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.
METHODSParticipants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.
RESULTSIn total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.
CONCLUSIONSHemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.