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Mortality Risk Factors in Patients Treated by Chronic Hemodialysis
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1982
Year
Weekly DialysisDialysisDialysis TherapyLogistic AnalysisMetabolic SyndromeGlomerulonephritisRenal FunctionChronic Kidney DiseaseAtherosclerosisHemodialysisKidney FailureEnd-stage Renal DiseaseUrologyRenal DiseaseCardiovascular DiseaseDiabetesDiabetic Kidney DiseaseChronic HemodialysisMedicineNephrologyFrench Dialysis Centers
A survival analysis of 1,453 French hemodialysis patients from 1972–1978, followed prospectively via the Diaphane Dialysis Registry, was performed. The analysis identified 198 deaths (43% cardiovascular), with age, male sex, primary renal disease (nephroangiosclerosis or diabetic nephropathy), high blood pressure, and twice‑weekly dialysis as significant risk factors, while low BMI, low cholesterol, and low predialysis urea were linked to higher overall and cardiovascular mortality, particularly stroke, indicating that poor nutrition and protein intake may contribute to the elevated cardiovascular risk in dialysis patients.
A survival analysis was applied to 1,453 patients treated between 1972 and 1978 in 33 French dialysis centers and prospectively followed up in the computerized Diaphane Dialysis Registry. 198 deaths (overall mortality = OM) were registered, of which 87 (43%) were secondary to cardiovascular complications (cardiovascular mortality = CVM). Risk factors for OM and CVM (p values less than 0.05) were age, male sex, nephroangiosclerosis or diabetic nephropathy as the primary renal disease, elevated systolic and diastolic blood pressure and two weekly dialysis rather then three. In contrast with the results observed for the general population, a high body mass index and elevated cholesterol, triglycerides and uric acid were not found to be associated with significantly increased CVM or OM. On the contrary, low body mass index (less than 20 kg/m2), low cholesterol (less than 4.5 mmol/l) and low mean predialysis blood urea (less than 4.6 mmol/l) were associated with increased OM and CVM, and more especially with high stroke mortality. Results for urea but not for cholesterol remain significant after adjustment for age, sex, weekly dialysis schedule and body mass index. They suggest that, in addition to elevated blood pressure, a poor nutritional state and/or low protein intake may be important factors for explaining the high cardiovascular mortality, particularly for strokes, observed in dialyzed patients.