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. 2020 Nov 23;21(1):502.
doi: 10.1186/s12882-020-02135-7.

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

Emily de Souza Ferreira  1 , Tiago Ricardo Moreira  2 , Rodrigo Gomes da Silva  3 , Glauce Dias da Costa  4 , Luciana Saraiva da Silva  5 , Samantha Bicalho de Oliveira Cavalier  2 , Beatriz Oliveira Silva  2 , Heloísa Helena Dias  4 , Luiza Delazari Borges  4 , Juliana Costa Machado  4 , Rosângela Minardi Mitre Cotta  4
Affiliations

Survival and analysis of predictors of mortality in patients undergoing replacement renal therapy: a 20-year cohort

Emily de Souza Ferreira et al. BMC Nephrol. .

Abstract

Background: optimal management of end-stage renal disease (ESRD) in hemodialysis (HD) patients should be more studied because it is a serious risk factor for mortality, being considered an unquestionable global priority.

Methods: we performed a retrospective cohort study from the Nephrology Service in Brazil evaluating the survival of patients with ESRD in HD during 20 years. Kaplan-Meier method with the Log-Rank and Cox's proportional hazards model explored the association between survival time and demographic factors, quality of treatment and laboratory values.

Results: Data from 422 patients were included. The mean survival time was 6.79 ± 0.37. The overall survival rates at first year was 82,3%. The survival time correlated significantly with clinical prognostic factors. Prognostic analyses with the Cox proportional hazards regression model and Kaplan-Meier survival curves further identified that leukocyte count (HR = 2.665, 95% CI: 1.39-5.12), serum iron (HR = 8.396, 95% CI: 2.02-34.96), serum calcium (HR = 4.102, 95% CI: 1.35-12.46) and serum protein (HR = 4.630, 95% CI: 2.07-10.34) as an independent risk factor for the prognosis of survival time, while patients with chronic obstructive pyelonephritis (HR = 0.085, 95% CI: 0.01-0.74), high ferritin values (HR = 0.392, 95% CI: 0.19-0.80), serum phosphorus (HR = 0.290, 95% CI: 0.19-0.61) and serum albumin (HR = 0.230, 95% CI: 0.10-0.54) were less risk to die.

Conclusion: survival remains low in the early years of ESRD treatment. The present study identified that elevated values of ferritin, serum calcium, phosphorus, albumin, leukocyte, serum protein and serum iron values as a useful prognostic factor for the survival time.

Keywords: Chronic kidney disease; biochemical parameter; End-stage renal disease; Hemodialysis; Renal replacement therapy.

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Conflict of interest statement

The authors declare that they have no competing interests.

Figures

Fig. 1
Fig. 1
- Kaplan–Meier survival curves of chronic hemodialysis
Fig. 2
Fig. 2
Cox regression and the risk factors; ESRD, leukocyte, serum protein, serum calcium
Fig. 3
Fig. 3
Cox regression and risk factors; ferritin, serum iron, serum albumin, serum phosphorus
See this image and copyright information in PMC

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