Analysis of risk factors for mortality of incident patients commencing dialysis in East Yorkshire, UK.
BACKGROUND
The change in the demographics and the presence of multiple risk factors and co-morbidities in UK patients starting dialysis may lead to poor survival on dialysis. Many of these risk factors are present in the pre-dialysis period allowing a potential window of opportunity to intervene with risk modification measures.


OBJECTIVE
To examine various potential factors that may predict early and overall mortality.


METHODS
We carried out an observational prospective study of a cohort of incident patients starting dialysis in a UK centre. Univariate analysis of factors and co-morbidities potentially affecting survival on dialysis were analysed to potential predictors. Factors affecting 1 year mortality were analysed using the t-test, the Mann-Whitney U-test or the chi-square test as appropriate. Mortality over the 5-year follow-up period was analysed using the Kaplan-Meier method.


RESULTS
Ninety-four patients [predominantly Caucasian (98%)], of mean age 63 years (15.6) (56% > 65 years) with a slight male preponderance were studied. Vascular disease (39%) and sepsis (33%) accounted for most of the deaths and a significant proportion of mortality was seen in the first year (56%). Patients with early mortality were older (68 vs. 61 years, P = 0.05) with lower haemoglobin (8.4 vs. 9.4 g/dl, P = 0.01) at the start of dialysis, commenced dialysis with a lower eGFR (5.4 vs. 6.5 ml/min/1.73 m(2), P = 0.06) and had more peripheral vascular disease (PVD) (39% mortality in patients with PVD vs. 18.5% in those without PVD, P = 0.04). Diabetes mellitus, high calcium phosphate product, older age and presence of vascular co-morbidities including ischaemic heart disease and peripheral vascular disease were associated with overall mortality over the 5-year follow-up period.


CONCLUSIONS
In this study, elevated calcium phosphate product and diabetes mellitus in addition to the presence of vascular disease were associated with poor survival. Patients with low haemoglobin and lower first pre-dialysis eGFR suffered higher early mortality. These potentially modifiable factors that could be identified in the pre-dialysis stage provide a valuable opportunity for intervention.
Cherukuri
A
A
Department of Renal Medicine, Hull and East Yorkshire Hospitals NHS Trust, UK.
Bhandari
S
S
D000367:Age Factors; D000368:Aged; D000704:Analysis of Variance; D002130:Calcium Phosphates / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D004739:England / Q000453:epidemiology; D005260:Female; D006454:Hemoglobins / Q000032:analysis; D006801:Humans; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality*; D012307:Risk Factors; D016019:Survival Analysis; D014652:Vascular Diseases / Q000453:epidemiology
D002130:Calcium Phosphates; D006454:Hemoglobins; D008055:Lipids; C020243:calcium phosphate