De Lima et al identified certain factors at baseline and during dialysis which can help distinguish dialysis patients who die early from those who may have an extended survival. The authors are from the Hospital Sao Cristovao in Sao Paulo, Brazil.


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


Extended Survival


> = 54


<= 42


< 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



• 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


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