Association of Dose and Frequency on the Survival of Patients on Maintenance of Hemodialysis in China: A Kaplan-Meier and Cox-Proportional Hazard Model Analysis
Yan Sun, Yankui Wang, Wenhong Yu, Yan Zhuo, Qian Yuan, Xiongfei Wu
(Department of Nephrology, East Campus, Renmin Hospital of Wuhan University, Wuhan, Hubei, China (mainland))
Med Sci Monit 2018; 24:5329-5337
Dialysis frequency and dose are controversial prognostic factors of hemodialysis morbidity and mortality. The aim of this study was to find out the effect of frequency and dosage of dialysis on mortality and survival in a group of Chinese hemodialysis patients.
MATERIAL AND METHODS: In total, 183 patients seen from February 2008 to January 2018, who were on maintenance hemodialysis for at least 3 months, were included in the study cohort. An anonymized database of age, gender, diabetic status, comorbidities, date of initiation of dialysis, hematological characters, biochemical variables, and status of survived or died was established from DICOM (Digital Imaging and Communications in Medicine) files of patients. Kaplan-Meier and Cox-proportional hazard model was used for calculation of survival over time at 95% confidence level.
RESULTS: Overall, the 10-year survival rate was 27%. Kaplan-Meier analysis showed patient survival as 94% at one-year, 59% at 5-years, and 27% at 10-years. Hemoglobin, serum albumin, calcium, potassium, phosphorous, calcium-phosphorous-products, and hemodialysis frequency and the dose had a significant effect on survival. Cox regression proportional hazard model showed that patients with serum albumin level of >4 g/dL were better associated with survival. Patients who underwent twice-weekly hemodialysis had 4.26 times less chance of survival as compared to patients with thrice-weekly hemodialysis. A higher dialysis dose of >1.2 spKt/V offered better survival as compared to a lower dose of <1.2 spKt/V.
CONCLUSIONS: Hypoalbuminemia, hemodialysis time, and hemodialysis frequency were significantly associated with mortality.
Keywords: Glomerular Filtration Rate, Hemodialysis Units, Hospital, Hypoalbuminemia, Kaplan-Meier Estimate, Kidney Failure, Chronic, Morbidity