[Survival of hemodialysis patients aged 65 years and more: correlation of albumin, hemoglobin, cholesterol concentration and comorbid diseases].
Today, the elderly are a fast growing population. Ever more patients aged > or = 65 are starting dialysis treatment. It is understood the they are a special and more sensitive group, due to their age and comorbid diseases. The aim of the study was to analyze the correlation of albumin, hemoglobin, cholesterol concentration and comorbid diseases at the beginning of treatment on the survival of patients aged > or = 65 years.


METHODS
Sixty-one patients starting hemodialysis (31 male and 30 female) were followed-up between January 1, 1995 and December 31, 1999. There survival was monitored until June 30, 2002. Study patients were divided in four groups according to years of survival: group 1--patients who died during the first year of treatment; group 2--patients who died in the second year of treatment; group 3--patients still alive in the third year up the fifth year of treatment; group 4--patients with >5-year survival. Group 1 had 17 patients (9 male and 8 female), mean age 71.4 +/- 4.3 years; group 2 15 patients (7 male and 8 female), mean age 71.2 +/- 3.9 years; group 3 25 patients (13 male and 12 female), mean age 70.3 +/- 4.4 years; group 4 four patients (two male and two female), mean age 71.0 +/- 5.0 years. There was no significant age difference among the groups. All patients received regular hemodialysis for 4 hours, three times per week. Cellulose diacetate membranes and bicarbonate dialysate were used in all patients.


RESULTS
The mean albumin value (g/L) at the beginning of dialysis was 31.9 +/- 5.9* in group 1, 35.3 +/- 6.4 in group 2, 38.1 +/- 6.6 in group 3, 41.8 +/- 6.7* in group 4 (p=0.017). The mean hemoglobin (g/L) value at the beginning of dialysis was 81.1 +/-14.3* in group 1, 85.7 +/- 20.5 in group 2, 86.4 +/- 14.5 in group 3, and 97.2 +/- 6.2* in group 4 (p=0.021). The mean cholesterol value (mmol/L) at the beginning of dialysis was 4.7 +/-1.1* in group 1, 5.1 +/- 1.8 in group 2, 5.2 +/- 1.5 in group 3, and 5.1 +/- 0.7* in group 4 (p=0.072). The greatest number of comorbid diseases were recorded in patients surviving for one year (4.6 +/- 1.2) and lowest in those surviving for more than five years (1.5 +/- 0.6) (p=0.001). In group 1, 70.6% of patients had five and more comorbid diseases. In group 2, 3 and 4, there were no statistically significant changes in albumin, cholesterol and hemoglobin concentrations during the first six months. Cardiac and cerebrovascular diseases were the most common cause of death.


CONCLUSIONS
Accordingly, shorter survival of elderly patients on hemodialysis correlated with lower albumin and hemoglobin values at the beginning of treatment. Also, patients with shorter survival rates had lower cholesterol values, however, without statistically significant differences. During the six month period there was no significant albumin increase in study patients. Shorter survival was associated with higher comorbidity. It is concluded that patients having appropriate albumin, hemoglobin and cholesterol values on starting dialysis therapy have better prognosis.
Orlić
Lidija
L
Odjel za nefrologiju i dijalizu, Klinika za internu medicinu, Klinicki bolnicki centar Rijeka, Hrvatska. lidija.orlic@ri.htnet.hr
Matić-Glazar
Durdica
D
Sladoje-Martinović
Branka
B
D000367:Age Factors; D000368:Aged; D002784:Cholesterol / Q000097:blood*; D005260:Female; D006454:Hemoglobins / Q000032:analysis*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000401:mortality / Q000628:therapy*; D008297:Male; D006435:Renal Dialysis; D012709:Serum Albumin / Q000032:analysis*; D015996:Survival Rate
D006454:Hemoglobins; D012709:Serum Albumin; D002784:Cholesterol