Patients who were clinically low risk without severe comorbid conditions underwent renal transplant.
Early death: within 90 days of starting dialysis
Extended survival: more than 10 years
Type of dialysis: primarily hemodialysis, with some patients receiving short intervals of peritoneal dialysis
Factors associated with short survival:
(1) older age
(2) malnutrition and hypoalbuminemia
(3) persistent systolic hypertension
(4) higher urea to creatinine ratio
(5) diabetes mellitus and risk factors for cardiovascular disease
(6) progressive anemia
Causes of death in patients with a short survival:
(1) cardiovascular disease, including sudden death or stroke
(2) malnutrition
(3) infection
(4) acute gastrointestinal bleeding
Factors seen in patients with extended survival:
(1) younger age
(2) decrease in systolic blood pressure
(3) stable body weight
(4) stable serum albumin
(5) increased hematocrit
(6) lower urea to creatinine ratio, which remained stable during dialysis
|
Baseline Factors
|
Early Death
|
Overlap
|
Extended Survival
|
|
age
|
> = 54
|
43-53
|
<= 42
|
|
albumin
|
< 3.5
|
3.5 - 4.0
|
> 4.0
|
|
urea to creatinine ratio
|
>= 18.4
|
13.6 - 18.3
|
<= 13.5
|
from Table 2, page 584, guestimates based on ranges shown
where:
• BUN and creatinine are in mg/dL/
Targeting the following may increase a dialysis patient's survival:
(1) nutritional support
(2) increasing the hematocrit (reducing anemia)
(3) good blood pressure control
(4) good diabetes control if diabetic
(5) control of other risk factors for coronary artery disease
(6) vaccinate and treat infections aggressively
