Einstein (São Paulo) (Sep 2007)
Index of coexisting disease and old age as predictors of survival in hemodialysis patients
Abstract
Objective: To identify the factors that may influence survival inpatients on chronic hemodialysis at a private hospital in Brazil.Methods: In this study, 99 patients in the CDE (Hemodialysis Unitof Hospital Albert Einstein) undergoing chronic hemodialysis for atleast 3 months were evaluated retrospectively over the period fromFebruary 2000 to October 2006. The following patient characteristicswere evaluated as possibly having an influence on survival: cause ofchronic renal failure (with and without diabetes mellitus), sex, age,albumin levels, C-reactive protein (CRP), hemoglobin levels and ICED(Index of Coexisting Disease), an instrument to assess the presence andseverity of comorbidities). Statistical analysis: Survival curves werecalculated by the Kaplan-Meyer method and the differences betweenthe curves were evaluated by a log-rank test. Results: The mean ageof patients was 63.14 ± 16.18 years, 34% of them were female and40% of them presented diabetes mellitus as the cause of chronic renalfailure. Mean albumin and hemoglobin levels on admission were 3.44± 0.58 g/dl and 10.55 ± 1.51 g/dl, respectively, and median CRP levelwas 9.55 g/dl. The distribution of patients by ICED was mild (25%),moderate (36%) and severe (38%). Thirty-three (33%) patients died,24 (24%) underwent renal transplantation, 5 (5%) were transferredto another dialysis unit, 36 (36%) continued dialysis treatment and1 (1%) recovered renal function. One-year survival was 80% and themedian survival period was 42.34 months (95% CI: 28.06-54.84).In univariate analysis, the following variables were associated withsurvival of patients: CRP levels on admission (RR: 1.39; 95% CI: 1.04-1.85; p = 0.026), age (RR: 1.049; 95% CI: 1.017-1.082; p = 0.028)and the level of ICED 3 compared with the level of ICED 1 (RR: 9.25;95% CI: 1.23-69.48; p = 0.03). In multivariate analysis, the followingvariables were associated with survival of patients: age (p = 0.0025)and severe ICED compared with mild ICED (p = 0.0341). Conclusion:The factors associated with survival of patients were advanced ageand severity of comorbidities. The utilization of ICED enables stratifyingthe dialysis patients according to severity of their comorbidities andit is useful to identify the patients with a greater risk of death andhospitalization, as well as to aid in the forecast of and optimization ofresources necessary for their treatment.