关键词: 血液透析,死亡,心血管并发症, 感染,早期生存率

Abstract:

Objective: To analyze the death causes in patients with hemodialysis, explore the risk factors affecting survival and provide some way to improve the survival of hemodialysis patients. Methodology: The causes of death in patients with hemodialysis were retrospectively analyzed during the periods Jan. 1998 to Dec. 2008.  Results: Two hundred and thirty seven cases in total eighty hundred eleven hemodialysis patients were died in the study period. Their average age at the beginning of hemodialysis was 63 (19 to 87) years old and men accounted for 60.8%. The median survival time was 9.6 (0.1 to 96.6) months. The main causes of death in our patients were cardiovascular disease (20.3%), infection (24.9%) and cerebrovascular disease (16.5%). [The proportion of females (43.7% vs 36.7%, P<0.05) and diabetic nephropathy as the underlying disease (25.0% vs 11.1%, P<0.05) was significantly higher and more patients had the history of left ventricular hypertrophy (9.6% vs 4.7%, P<0.05) and congestive heart failure (23.3% vs 13.4%, P<0.05) before hemodialysis in patients died due to cardiovascular and cerebrovascular diseases whose BMI (21.1 vs 23.6 kg/m2, P<0.05) and eGFR (7.6 vs 10.0 ml/min•1.72m2, P<0.05) before hemodialysis were lower]. Logistic regression analysis revealed that lower BMI, the history of left ventricular hypertrophy and congestive heart failure before hemodialysis were the risk factors of dying due to cardiovascular and cerebrovascular diseases. The patients died from infection were older (66 vs 62 years old, P<0.05) and their blood albumin before hemodialysis was lower (30.2 vs 33.1g/L, P<0.05). Logistic regression analysis showed that older patients, lower blood albumin before hemodialysis were the risk factors of dying from infection. 33.3 percent of the all deaths died within 3 months of hemodialysis.The main causes of death were infection (38.0%), cardiovascular diseas e(22.8%) and cerebrovascular disease (11.4%) in patients died within 3 months of hemodialysis. The proportion of chronic glomerulonephritis(CGN) as underlying disease was significantly lower (20.6% vs 36.2%, P<0.05). More patients had the history of congestive heart failure (19.4% vs 16.3%, P<0.05) and Charlson comorbidity index (CCI) =5-10 before hemodialysis in patients died within 3 months of hemodialysis and their blood calcium(1.91 vs 2.18mmol/L, P<0.05), blood albumin (29.2 vs 34.7g/L, P<0.05) and eGFR (7.55 vs 10.29 ml/min•1.72m2, P<0.05) before hemodialysis was significantly lower. Logistic regression analysis showed that lower blood albumin, lower eGFR, the history of congestive heart failure and CCI≥5 before hemodialysis were the risk factors of dying within 3 months of hemodialysis. Conclusion: Cardiovascular and cerebrovascular diseases, infection are the main causes of death in hemodialysis patients. There is a higher risk of death within 3 months of hemodialysis especially in patients whose blood albumin is lower, CCI≥5 and who have the history of congestive heart failure before hemodialysis and start hemodialysis late. Improvement of the nutritional status of patients, prevention and treatment of cardiovascular and cerebrovascular diseases and infection complications of hemodialysis and starting hemodialysis early properly should be emphasized to improve the early survival of hemodialysis.