Survival on chronic dialysis: 10 years' experience of a single Colombian center

Abstract

Using a retrospective cohort study, we evaluated survival and mortality risk factors in our dialysis population at the Renal Unit, RTS Cauca--Nephrologic San Jose, Popaydn, Cauca, Colombia. In the study, we included patients with chronic renal failure who started dialysis therapy during the period 1994-1999, and who remained on dialysis for a minimum of 5 years. Endpoints (living, died, lost to follow-up) were evaluated at the end of the study (July 2004), and a Kaplan-Meier survival analysis was performed. Mortality risk was analyzed using the multivariate Cox proportional hazard model. The study included 236 patients (129 on peritoneal dialysis and 107 on hemodialysis), whose mean age (+/- standard deviation) was 54.5 +/- 15.6 years. Of the group, 51% were women, 68.7% were urban dwellers, and 31.3% were rural dwellers. Major causes of end-stage renal disease included chronic glomerulonephritis (43.2%), diabetic nephropathy (35.7%), and hypertensive nephropathy (6.0%). The racial origins of the study population were half-caste (80.7%), Afro-Colombian (8.8%), indigenous (7.6%), and white (2.6%). Median (+ standard error) survival on hemodialysis was 66 +/- 10 months. Median survival on peritoneal dialysis was 57 +/- 7 months. Among patients with diabetes, median survival on hemodialysis was 40 +/- 13 months, and on peritoneal dialysis, it was 38 +/- 4 months. Major causes of mortality included sudden death (40%), infection (25%), and cardiovascular causes (22.5%). Significant mortality risk factors for hemodialysis patients were congestive heart failure (p = 0.01) and albumin <3 g/dL (p = 0.01). For peritoneal dialysis patients, the significant risk factors were diabetes mellitus (p = 0.01) and albumin < 2.5 g/dL (p = 0.02). Patient survival in our setting is similar to that reported in other series. The strongest predictive factors for mortality were diabetes mellitus, congestive heart failure, anemia, and hypoalbuminemia.