Influences Of Starting Hemodialysis Time On Patients Outcome-a Retrospective Single Center Study

Objective: To analyze the clinical data of patients with long-term maintenance hemodialysis in our hospital,to explore the relationship between the timing of dialysis and the prognosis of patients and the prognostic factors in order to take more targeted measures to intervene,thereby improving the prognosis of dialysis patients.Methods: Select patients with chronic renal failure starting hemodialysis in the Fifth People Hospital of Shanghai affiliated to Fudan University between January 1,2003 to December 31,2015.A total of 212 cases were included.The demographic and the clinical data of these patients were collected on the beginning of dialysis including age,gender,primary disease,first hemodialysis vascular access,start time of hemodialysis,end time of hemodialysis,serum creatin,blood urea nitrogen(BUN),blood uric acid(BUA)and some other laboratory parametes.These patients were divided into two groups,A group: e GFR>5 ml/min/1.73㎡,B group:e GFR ≤5ml/min/1.73㎡.A group included 101 patients and B group include 111 patients.The data of the normal distribution were described by mean ± standard deviation,and the t test was used between the two groups;The chi-square test was used to compare the differences between the two groups.Analyzed the distribution of e GFR and the trend of e GFR which is changed by years.Kaplan-Meier method was used to compare two groups survival time.Cox regression analysis was performed to find the factors which affected on survival.P<0.05 has statistical significance.All cause death was regarded as outcome event in this study.Results:(1)212 patients were included in the study,of whom 80 patients were died.The number of deaths in group A was 41,the proportion was 40.59%;the number of deaths in group B was 39,accounting for 35.14%.There was no significant difference in the age of patients between group A and group B(P = 0.057).There was no significant difference in gender ratio between groups A and B(P=0.070).(2)The primary disease of the patients included diabetic nephropathy,chronic glomerulonephritis,primary hypertension(hypertensive nephropathy),polycystic kidney disease et al,Including 45 patients with diabetes,37 patients with chronic glomerulonephritis,27 patients with essential hypertension,12 patients with polycystic kidney disease.Chronic glomerulonephritis is the first major disease in group A,and diabetic nephropathy is the first major disease in group B.There was no difference in vascular access between the two groups.(3)For the whole,the average value of the e GFR values at the beginning of dialysis calculated using the CKD-EPI formula was 5.35 ± 2.637 ml /(min · 1.73 ㎡);This e GFR gradually increased from 2003 to 2014.(4)The mean value of hemoglobin(HB)in group A was higher than that in group B,and the mean value of albumin,serum creatinine,urea nitrogen,uric acid,serum potassium,serum phosphorus,parathyroid hormone and total cholesterol in group A are lower than Group B.(5)Kaplan-meier survival curve showed no difference in survival time between group A and group B.(6)The correlation analysis showed that the factors associated with survival of the patient were age,total protein,and albumin.Age and survival were negatively correlated;total protein and albumin and survival was positively correlated.(7)The results of single factor analysis showed that e GFR(P = 0.810)had no significant relationship with survival prognosis at the time of initiation of dialysis.However,age(p = 0.019),age of dialysis(p = 0.000),primary vascular pathway(p = 0.011),total protein(P> 0.008)and albumin(p = 0.002)were the prognostic factors.These factors were included in the cox multivariate survival analysis to conclude that age was a risk factor(OR> 1,p = 0.015).The risk of death increased by 2.4% for every 1 year of age.Dialysis age is a protective factor(OR <1,p = 0.000),whenever the patient dialysis age increased by 1 year,the risk of death decreased by 1.9%.Conclusion:(1)We did not find that the timing for hemodialysis initiation has effect on patients death in this study;(2)With the decline of e GFR,patients with anemia,hyperlipidemia gradually increased,the occurrence of high potassium,and other metabolic disorders increased,the degree of secondary hyperparathyroidism also increased.(3)The correlation analysis showed that the patient’s age,total protein level and albumin level were closely related to the survival of the patients.The older ones were less beneficial to survival,the higher levels of the total protein and albumin,the more beneficial to survival.Therefore,hemodialysis patients should be as much as possible to maintain a relatively good nutritional status.(4)Analysis of cox regression model showed that the age of the patients was the risk factor of the prognosis of the patients.Dialysis age is the protective factor.Patients should try their best to maintain a relatively good nutritional status.