The Analysis Of The Death Etiology And Risk Factors In Maintenance Hemodialysis Patients

Objective:To analyze 102 patients with maintenance hemodialysis(MHD)in blood purification center of Chizhou people,s hospital,and find the cause of death and risk factors of MHD patients,so as to improve the quality of MHD patients,and also provide the evidence for improving hemodialysis quality,prognosis and survival time of them.Methods:Retrospectively analyze 102 MHD patients(from January 2011 to December2014)in People,s Hospital of Chizhou,(follow-up until October 31,2015),the patients who died during follow-up period were divided into death group(41 cases),and the patients who still survive at the end of follow-up period patients were divided into survival group(61 cases).By summarizing the cause of death,survival time and maintaining hemodialysis time,and analyzing impact of gender,age,blood pressure before dialysis,the primary disease,frequency of dialysis,dialysis method,hemoglobin,albumin,phosphorus,calcium,parathyroid hormone on survival time of patient,to explore the cause of death and risk factors for death in MHD patients.Results:Three main etiology were chronic glomerulonephritis(51.9%),diabetic nephropathy(21.6%),hypertensive nephropathy(19.6%).A total of 41 cases died during 5years,17(41.5%)cases died of cardiovascular disease(including 8 cases of cardiac arrest,8 cases of heart failure,1 case of acute pulmonary edema),8 cases(19.5%)died of cerebral hemorrhage,5 cases(12.2%)died of infection(including 4 cases of pulmonary infection,1 case of catheter related infections),4 cases(9.8%)died of uremic encephalopathy,3 cases(7.3%)died of malignant tumor,4 cases(9.7%)died of in other diseases(including 1 case of hyperkalaemia,gastrointestinal bleeding,injury,and suicide each).Overall survival rate of 1,2,3,4,5 years for 102 MHD patients are 98%,89%,82%,76%,59% respectively.As the the duration of dialysis prolonged,MHD patients survival rate declined year by year.By using the single factor of Kaplan Meier-survival analysis and the Log-rank test of survival curves,we can find that age,diabetic nephropathy,high blood pressure,hemoglobin,albumin,phosphorus,frequency of dialysis and dialysis method is the independent risk factors of death in MHD patients,sex is not the independent risk factors of death in patients with MHD.Cox regression model was used to make multi-factor analysis and found that :hemoglobin,blood pressure,albumin,frequency of dialysis,blood phosphorus is the main factor for survival of MHD patients.The lower the frequency of dialysis,hemoglobin and albumin,the greater the risk of death.Patients with higher blood pressure and phosphorus,the greater the risk of death.Conclusion:Chronic glomerulonephritis,diabetic nephropathy and hypertensive nephropathy were the top three etiologies for MHD patients.Cardiovascular disease,cerebral hemorrhage and infection were the top three causes of death for patients with MHD.Hemoglobin,blood pressure,albumin,frequency of dialysis,blood phosphorus is the main factor for survival of MHD patients.The lower the frequency of dialysis,hemoglobin and albumin,the greater the risk of death.Patients with higher blood pressure and phosphorus,the greater the risk of death.