title: Predictive Factors of One-Year Mortality in a Cohort of Patients Undergoing Urgent-Start Hemodialysis.
abstract: Chronic kidney disease (CKD) affects 10-15% of adult population worldwide. Incident patients on hemodialysis, mainly those on urgent-start dialysis at the emergency room, have a high mortality risk, which may reflect the absence of nephrology care. A lack of data exists regarding the influence of baseline factors on the mortality of these patients. The aim of this study was to evaluate the clinical and laboratory characteristics of this population and identify risk factors that contribute to their mortality.
  
  
  
  We studied 424 patients who were admitted to our service between 01/2006 and 12/2012 and were followed for 1 year. We analyzed vascular access, risk factors linked to cardiovascular disease (CVD) and mineral and bone disease associated with CKD (CKD-MBD), and clinical events that occurred during the follow-up period. Factors that influenced patient survival were evaluated by Cox regression analysis.
  
  
  
  The patient mean age was 50 ± 18 years, and 58.7% of them were male. Hypertension was the main cause of primary CKD (31.8%). Major risk factors were smoking (19.6%), dyslipidemia (48.8%), and CVD (41%). Upon admission, most patients had no vascular access for hemodialysis (89.4%). Biochemical results showed that most patients were anemic with high C-reactive protein levels, hypocalcemia, hyperphosphatemia, elevated parathyroid hormone and decreased 25-hydroxy vitamin D. At the end of one year, 60 patients died (14.1%). These patients were significantly older, had a lower percentage of arteriovenous fistula in one year, and low levels of 25-hydroxy vitamin D.
  
  
  
  The combined evaluation of clinical and biochemical parameters and risk factors revealed that the mortality in urgent-start dialysis is associated with older age and low levels of vitamin D deficiency. A lack of a permanent hemodialysis access after one year was also a risk factor for mortality in this population.
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciene P
authors.initials: LP
authors.lastname: Magalhães
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Luciene M
authors.initials: LM
authors.lastname: Dos Reis
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Fabiana G
authors.initials: FG
authors.lastname: Graciolli
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.|Medicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
authors.forename: Benedito J
authors.initials: BJ
authors.lastname: Pereira
authors.affiliation: Nephrology Division, School of Medical Sciences, University of Campinas (UNICAMP), Campinas, Brazil.
authors.forename: Rodrigo B
authors.initials: RB
authors.lastname: de Oliveira
authors.affiliation: Department of Psychobiology, Federal University of São Paulo (UNIFESP), São Paulo, Brazil.
authors.forename: Altay A L
authors.initials: AA
authors.lastname: de Souza
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.|Medicine Master Degree Program, Universidade Nove de Julho (UNINOVE), São Paulo, Brazil.
authors.forename: Rosa M
authors.initials: RM
authors.lastname: Moyses
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Rosilene M
authors.initials: RM
authors.lastname: Elias
authors.affiliation: Nephrology Division, Medical School, University of São Paulo, São Paulo, Brazil.
authors.forename: Vanda
authors.initials: V
authors.lastname: Jorgetti
mesh_terms: D000328:Adult; D000368:Aged; D002097:C-Reactive Protein / Q000032:analysis; D002318:Cardiovascular Diseases / Q000150:complications; D004636:Emergency Service, Hospital; D005260:Female; D006801:Humans; D006973:Hypertension / Q000150:complications; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009398:Nephrology / Q000706:statistics & numerical data; D010343:Patient Admission; D011237:Predictive Value of Tests; D016016:Proportional Hazards Models; D011446:Prospective Studies; D006435:Renal Dialysis; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D012907:Smoking; D017741:Survivors; D014807:Vitamin D / Q000031:analogs & derivatives / Q000097:blood; D014808:Vitamin D Deficiency
chemical_list: D014807:Vitamin D; D002097:C-Reactive Protein; C104450:25-hydroxyvitamin D