Analysis Of New Cases Of Maintenance Hemodialysis In Yan’an City In Recent 6 Years

Objective:Through analysis of 345 new patients with maintenance hemodialysis(MHD)in Yan’an City from January 2013 to December 2018,this paper aimed to describe and summarize the characteristics and related factors of the study subjects,and to provide evidence for early prevention,patient management and prognosis judgement.Methods:This study used case analysis method.The subjects were patients who received MHD treatment in the Affiliated Hospital of Yan’an University and the hemodialysis center of Yan’an People’s Hospital from January 2013 to December 2018.Relevant data were collected mainly by consulting patients’ medical records.The main contents included age,sex,occupation,reason of first visit,primary disease,choice of vascular access,dialysis mode,common complications,prognosis within one year of dialysis,causes of death within one year of dialysis,etc.Excel data files were established using Excel,and statistical analysis was carried out with SPSS20.0 software package.The main analysis indicators were rate and composition ratio.Results:1.The sex ratio of the subjectsFrom 2013 to 2018,there were 345 newly added patients with MHD,including 219males(63.48%)and 126 females(36.52%).There were more male patients than female patients in every year.2.Age distribution of the subjectsThe largest proportion of 345 MHD patients was 41 to 50 years old,accounting for22.32%(77/345),followed by 51 to 60 years old(20.00%;69/345).The proportion of MHD patients aged 41 to 60 years was(42.32%;146/345)and the proportion of MHDpatients aged 31 to 70 years was 76.52%(264/345).The age distribution of those MHD patients in each year was basically the same as that of the total patients.The age of patients in each year from 2013 to 2018 was 44.75±14.25、47.52±14.71、48.89±14.38、50.96±18.95、51.43±16.35、50.70±16.14,After anova,P=0.75,the difference was not statistically significant.3.Occupational composition of the subjectsAmong 345 new MHD patients,157(45%)were farmers,68(20%)were residents and64(19%)were workers,48(14%)were cadres and 8(2%)were students.4.Composition of reasons for first visitAmong 345 new patients with MHD,the first reason was edema(31.01%),followed by symptoms of abnormal fingdings in blood,urine or B-mode ultrasound examination(16.81%),nausea and vomiting(15.65%)and fatigue with backache(10.72%).Those top four reasons accounted for 74.19% of total patients.5.Composition of primary diseases in the study subjectsChronic glomerular nephritis(CGN),Diabetic nephropathy(DN)and Hypertension nephropathy(HN)were the top three primary diseases among 345 new MHD patients,accounting for 39.42%(136/345),22.32%(77/345)and 11.01%(38/345),respectively;the fourth was IgA nephropathy,and the remaining types included obstructive nephropathy(ON),polycystic kidney disease and others(including those rare types such as allergic purpuric nephritis and unknown pathological types).The proportion of the top three primary diseases in each year was basically consistent with the distribution of those total patients.6.Composition of vascular access in the study subjectsAmong 345 new patients with MHD,arteriovenous fistula was the most frequently selected method(245 cases;71.02%),followed by semi-permanent venous catheterization(61 cases;17.68%)and temporary venous catheterization(39 cases;11.30%).7.Composition of dialysis methods in the study subjectsOf 345 new MHD patients,160(47%)chose hemodialysis alone,108(31%)chose HD+ intermittent Hemofiltration(HF),and 77(22%)chose HD+intermittent Hemoperfusion(HP).8.Common complications of dialysis in the study subjectsAmong 345 subjects,92.76%(320/345)and 90.43%(312/345)were complicated with renal anemia and renal hypertension,followed by chronic kidney disease-mineral and bone disorder(CKD-MBD),secondary hyperparathyroidism,uremic cardiomyopathy and uremic encephalopathy.9.The outcomes of dialysis in one yearWe analyzed dialysis outcomes in one year of 269 MHD patients in the past five years,and found that the surviving patients was the largest part,accounting for 67.7%(185/269),and ranked the first in each year.The number of patients who gave up or died decreased year by year.The proportion of transferred patients increased year by year from 2013 to 2016,but decreased in 2017.The number of renal transplant recipients increased year by year,and no peritoneal dialysis recipient was found.10.The number of deaths in one year after dialysis and their causesFrom January 2013 to December 2017,the mortality rate of new MHD patients during one year of dialysis was highest in 2013 and lowest in 2015,and the mortality rates were26.90%(7/26)and 6.30%(4/63),respectively.Cardiocerebrovascular disease was the leading cause of death in one year after dialysis.The age of died patients was mainly over 61 years old,most died patients were male,and DN was the primary disease.Conclusion:1.The total number of new MHD patients and elderly patients in Yan’an City has increased year by year in the past six years,with more males than females and the largest number of farmers,Age distribution was not statistically significant.2.The first three primary diseases of newly added MHD patients in Yan’an City in the past six years were CGN,DN and HN.More than two-thirds of new MHD patients used arteriovenous fistula,and nearly half of them were hemodialysis alone.The first three major complications were renal anemia,renal hypertension and electrolyte disturbance.3.The proportion of survivors of new MHD patients in Yan’an City increased year byyear in the past years,while the proportion of deaths and abandonment decreased year by year.The main cause of death was DN.The direct cause of death was cardiovascular and cerebrovascular diseases.The age of the dead increased year by year.