Clinical features of ESRD patients at the initiation of dialysis

Shin, Jin Ho; Lee, Young Ki; Kim, Sang Wook; Kwon, Young Joo; Pyo, Heui Jung

Abstract

BACKGROUND: Up to now, no study have been reported about clinical features of ESRD patients at the initiation of dialysis and their outcomes in Korea. We studied the clinical features and survival predictors of ESRD patients at the initiation of dialysis therapy and their outcomes and we tried to identify the optimal point of starting dialysis therapy according to age, underlying disease, and other variables.
METHODS
We studied retrospectively clinical and laboratory variables of initiation in 364 patients who started dialysis therapy first at Korea University Guro hospital from 1987 to 1997. We divided patients into 3 groups by age, into 2 groups by underlying renal disease(DM vs. nonDM) and compared the above variables between 3 or 2 groups. We evaluated the outcome(alive vs. death) in 258 patients whoes outcomes were identified. We identified the poor survival predictors of outcome according to alive / death group, and analized the relative risk of death according to level of serum creatinine (reference: 12.5-15.0 mg/dL) and serum albumin (reference: 4.0-4.5 g/dL).
RESULTS
1) The distribution of patients by age, young age group, middle age group, old age group were 135, 140 and 89. Those of patients by underlying renal disease, DM and nonDM were 80 and 284 respectively. 2) The most common underlying renal disease of young age group was chronic glomerulonephritis but that of old age group was diabetes mellitus. In old age group, levels of BUN, serum creatinine, and serum phosphate were lower than those in young age group(P<0.001). In old age group, the indication of dialysis tended toward relative(p=0.098) and early referral was more common than in young age group. 3) DM group was older and more early referred than nonDM group. In DM group, blood cholesterol level was higher, but level of BUN, serum creatinine, albumin, phosphate and uric acid were lower than those in nonDM group. 4) In 258 patients whose outcomes were identified, elderly and DM had poorer outcomes in the respect of mortality and survival by Kaplan-Meier survival analysis method. In the comparison of death group and alive group, death group was older and had more DM as underlying renal disease and lower level of serum creatinine than alive group. 5) Relaive risk of death was higher in lower concentrations comparing to reference level of albumin and creatinine.
CONCLUSION
Old age, DM as underlying renal disease, hypoalbuminemia and hypocreatinemia were poor survival predictors. Then close observation and follow-up are warranted in patients with old age, DM, hypoalbuminemia, and hypocreatinemia. For more favorable prognosis in ESRD patients, early initiation of dialysis must be considered in patients who have these characteristics.