Analysis of New Cases of Hemodialysis in a Single Center in Recent Five Years

Abstract

Background Hemodialysis (HD) is one of the most important therapy options for people with end-stage renal disease (ESRD) . ESRD patients require long-term dialysis, which brings a huge burden to society and families. Therefore, a deep understanding of the epidemiological characteristics and changing trends of hemodialysis patients is the key to prevention and treatment. Objective To investigate the 662 new first-time HD patients admitted to our center between 2016 and 2020, as well as dialysis patient trends in our center, in order to provide a basis for further improving dialysis quality and prognosis. Methods The primary disease data of newly added HD patients in the blood purification center of Affiliated Hospital of Jiangsu University from 2016 to 2020 were retrospectively analyzed according to factors such as year, gender, age, cause of first visit, primary disease, selection of primary vascular pathway and long-term vascular pathway, and death causes of dialysis patients in the previous year. Results (1) There were 662 new HD patients, with a male to female ratio of 1.38:1. (2) Newly added HD patients >40 years old accounted for 90.0%, and patients aged 61-70 accounted for the highest proportion of 28.1%. (3) The top three main illnesses among HD patients were diabetic kidney disease (DKD) , chronic glomerulonephritis (CGN) , and hypertensive nephropathy (HN) ; the primary disease of HD patients aged 21~40 was mainly CGN, the primary disease aged 41~70 was mainly DKD, and the primary disease aged 41~70 were mainly DKD and HN. (4) Non-tunneled catheters (NTC) accounted for 76.9% (509/662) ; arteriovenous fistulas (AVF) accounted for 19.9% (132/662) ; and after admission, 82.1% (256/312) patients chose AVF and 9.0% (28/312) patients chose dialysis catheters (TCC) with tunnel and polyester sleeve. (5) Renal anemia, renal hypertension, digestive tract symptoms, metabolic acidosis, heart failure, and other cardiovascular events are the most common complications, accounting for 100.0% (662/662) , 77.0% (510/662) , 66.2% (438/662) , 50.2% (332/662) and 43.2% (286/662) respectively. (6) After one year, 96.8% (641/662) of the patients survived, with the annual proportion of patients who gave up and died decreasing year by year; the annual proportion of patients who chose kidney transplantation and switched to peritoneal dialysis fluctuated slightly; cardiovascular and cerebrovascular events were the main cause of death within one year of follow-up. Conclusion From 2016 to 2020, the majority of new primary HD patients in our center are middle-aged and elderly, with males having a higher prevalence rate than females. DKD, CGN, and HN are the most common causes of ESRD, with DKD and HN onset ages older than CGN. NTC is still the main vascular access for primary dialysis. Renal anemia, renal hypertension, gastrointestinal symptoms, metabolic acidosis, heart failure and other cardiovascular events are the main complications of primary HD patients. Patients' awareness of seeking medical treatment and nephrologists' continuous education should be improved in order to achieve the timely establishment of long-term vascular access for patients and timely dialysis treatment. Simultaneously, the possibility of cardiovascular and cerebrovascular events in male DKD patients with high new age of HD needs attention, and intervention measures should be taken to reduce their mortality.

Keywords

• kindney diseases|hemodialysis|diabetic nephropathies|vascular access devices|renal replacement therapy|primary disease