A Retrospective Analysis Of Timing For Hemodialysis Initiation In A Single Center

Objective To investigate the relationship between the timing of hemodialysis initiation and survival,and the risk factors at the start of the hemodialysis which effect on survival of the chronic renal failure patients.Methods Chronic renal failure patients starting hemodialysis in the First Affiliated Hospital of Dalian Medical University between January 1,2008 and December 30,2015 were enrolled in this retrospective cohort study,followed until December 31,2015.Patients were classified into four groups according to e GFR using the MDRD formula by≤5ml/min/1.73m2,5-10ml/min/1.73m2,10-15ml/min/1.73m2,15-30 ml/min/1.73m2,called A,B,C,D group respectively.We compared the four groups of sex,age,first hemodialysis vascular access,primary disease,complications,laboratory parameters and the cause of death.Analyzed the distribution of e GFR-MDRD and the trend of e GFR which is changed by years.Kaplan-Meier method was used to compare four groups survival time.Cox regression analysis was performed to find the factors which effected on survival.P<0.05 has statistical significance.Results 1.The male to female ratio has no difference between four groups(P=0.295);Central venous catheters to internal arteriovenous fistula ratio has difference between four groups(P=0.176);Age had differences between four groups(P=0.01).2.The most common primary diseases of group A、B is glomerulonephritis;the most common primary disease of group C、D is diabetic nephropathy.3.The average of e GFR at the start of hemodialysis is 6.138±3.548ml/min/1.73m2(MDRD equation).The e GFR of most research objects at the start of hemodialysis are lower 5ml/min/1.73m2.4.The leading cause of death is sudden death in group A(26.67%),followed by cancer and cardiovascular events(20.00%);The leading cause of death is infection in group B(36.36%),followed by cancer and cerebral hemorrhage(18.18%);The cause of death are infection,hemorrhage of digestive tract and multiple organ failure in group C(33.33%);The cause of death is myocardial infarction in group D(100%).5.Group C has the highest 1,3-year survival rate(100%,93.3%),followed by group A(95.2%,90.2%),group B(93.2%,89.9%),group D(87.5%,87.5%).Group A has the highest 2-year survival rare(95.32%),follow by group C(93.3%),group B(89.9%),group D(85.7%);Group B has the highest 5-year survival rate(83.8%),followed by group A(83.0%).There is no significant difference of survival time between different groups(P>0.1).6.Univariate Cox regression analysis: age,diabetic nephropathy,hypertension,diabetes,cardiovascular disease,acute left ventricular failure/pulmonary edema,hyperkalemia and infection at the start of hemodialysis were risk factors affecting prognosis.Arteriovenous fistula,creatinine and renal hypertension were benefit factors affecting prognosis.when serum creatinine increased 1mmol/L,the risk of death decreased by 0.1%.e GFR(MDRD formula,C-G formula,CKD-EPI equation)at the start of hemodialysis had no significant effect on survival(P= 0.594,0.746,0.865).Multivariate Cox regression analysis: Age was the risk factor affecting prognosis,with the risk of death increased by 5.9% when the age increased 1 year.Arteriovenous fistula was benefit factors.Conclusion 1.We did not find that the timing for hemodialysis initiation has effect on prognosis in this study,but compared with the group of higher e GFR at the start of hemodailysis,we found that age decreased,the number of diabetes,hypertension and cardiovascular disease decreased,the number of acute left heart failure/pulmonary edema decreased,hyperphosphatemia and secondary hyperparathyroidism became serious,serumcreatinine,urea nitrogen increased in the group of lower e GFR.2.Univariate Cox regression analysis: age,diabetic nephropathy,hypertension,diabetes,cardiovascular disease,acute left ventricular failure/pulmonary edema,hyperkalemia and infection were risk factors affecting prognosis.Arteriovenous fistula,creatinine and renal hypertension were benefit factors.Multivariate Cox regression analysis: Age was the risk factor affecting prognosis,with the risk of death increased by 5.9% when the age increased 1 year.Arteriovenous fistula was benefit factors.