Abstract: FR-PO803

Risk Factors Associated with Early Mortality in Patients Commencing Maintenance Hemodialysis: A Systematic Review

Session Information

Category: Dialysis

  • 601 Standard Hemodialysis for ESRD

Authors

  • Hazara, Adil Mohammad, Hull and East Yorkshire Hospitals NHS Trust, Hull, Hull, United Kingdom
  • Bhandari, Sunil, Hull and East Yorkshire Hospitals NHS Trust and Hull York Medical School, East Yorkshire, Hull, United Kingdom
Background

Early mortality rates are reported to be high in patients starting hemodialysis (HD) for end-stage renal disease (ESRD). We have conducted a systematic review of literature in order to evaluate the risk factors associated with early mortality in this patient population.

Methods

Medline and EMBASE databases were searched for studies published in English language between 1/1/1985 and 31/7/2015. Early mortality was defined as deaths within 180 days of starting HD. Case-control and cohort studies involving adult subjects commencing HD for ESRD were included. The Quality in Prognosis Studies tool was used to assess risk of bias in individual studies. Data extracted from the studies included information on population characteristics and settings. In addition, patient or treatment related factors studied with reference to their relationship with the risk of early mortality were documented. The findings were summarised and a narrative account was drawn from the available evidence.

Results

21 studies with a combined population of 1,016,646 new dialysis starters were included (median number of subjects: 825; range: 148 - 498,566). There were 15 cohort and 6 case-control studies. Risk of bias was low, medium and high in 5, 3 and 13 studies respectively. A total of 39 different risk factors for early mortality were extracted; broadly, these belonged in 4 categories: clinical, demographic, laboratory and socioeconomic risk factors. Early mortality was associated with patient age, serum albumin at the start of dialysis, not starting HD with functioning arteriovenous fistula, having diabetes as the cause of ESRD, history of heart failure or malignancy, increased frailty, absence of previous nephrological care and deficiency of 25-OH vitamin D. Factors that were not associated with early mortality were gender, having diabetes (as a comorbid condition), serum haemoglobin, parathyroid hormone levels, serum calcium and phosphate.

Conclusion

This systematic review identifies several important modifiable risk factors for early mortality. Studies examining the effects of modification of these risk factors are urgently needed.