NDT Advance Access originally published online on July 7, 2007
Nephrology Dialysis Transplantation 2007 22(12):3568-3572; doi:10.1093/ndt/gfm424
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Factors associated with mortality in patients new to haemodialysis
1Division of Renal Diseases and Hypertension, University of Colorado HSC, Denver, CO, 2Division of Cardiology, Emory University School of Medicine, Atlanta, GA, 3Computer and Statistical Consultants, Inc., Santa Barbara, CA and 4Denver Nephrology, Denver, CO, USA
Correspondence and offprint requests to: David M. Spiegel, MD, University of Colorado Health Sciences Center, 4200 E. 9th Avenue, Box C-281, Denver, CO 80262, USA. Email: david.spiegel{at}uchsc.edu
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Abstract |
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Background. Patients receiving dialysis therapy for end-stage kidney failure have a high cardiovascular mortality that can only be partially explained by traditional risk factors.
Methods. This study was a post hoc analysis of a prospectively gathered data set from a randomized trial comparing outcomes in new haemodialysis patients treated with sevelamer or calcium-containing phosphate binders. Patients were followed from the time of enrollment until death or censor on 31 December 2005. Median follow-up was 3.6 years. Demographics, cardiovascular risk factors, laboratory data, medication use and severity of vascular calcification were available at baseline and over the first 18 months of dialysis.
Results. Baseline predictors of mortality included age, creatinine, heart rate, iPTH, C-reactive protein (CRP), coronary and aortic calcium scores and the presence of aortic valve calcification. Over the first 18 months, averages of diastolic blood pressure, BUN, creatinine, albumin, phosphorus, iPTH and CRP were all significantly different between survivors and non-survivors. A stepwise multivariable adjusted Cox regression model demonstrated that low BUN and albumin and high CRP along with the use of calcium-containing phosphate binders (rather than sevelamer) were the strongest predictors of mortality in patients new to haemodialysis.
Conclusions.These findings suggest that non-traditional risk factors, such as inflammation and malnutrition measured during the first 18 months of dialysis, are important determinates of survival in new dialysis patients. In addition, the unique risk factor for dialysis patients, the use of calcium-containing phosphate binders, was associated with a higher mortality rate in patients new to dialysis.
Keywords: ESRD; malnutrition inflammation; mortality; phosphate binders; haemodialysis; vascular calcification
Received for publication: 20.12.06
Accepted in revised form: 5. 6.07
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