Basal Serum Biochemical Markers as a Predictor of Survival in Patients Undergoing Hemodialysis

Song, Kee San; Lee, Seoung Woo; Kwon, Kun Ho; Jeon, Jeong Bae; Bae, Sung Kwon; Chi, Dong Han; Kim, Moon Jae

Abstract

To investigate the influence of first six-month mean for serum biochemical markers, albumin, cholesterol, triglyceride, inorganic phosphate, BUN, creatinine, on survival in hemodialysis, we retrospectively analyzed the 57 patients who were monitored from the start of HD for more than 6 months between January 1988 and December 1995. Exclusion criteria were as follows: transfer to CAPD, transplantation or another dialysis center, HD for less than 6 months, non-compliant, death due to malignant disease, accident and self-withdrawal. The patients were divided into two groups according to the demographic characteristics and the median value of first six-month mean for serum biochemical markers. The mean age was 46.7+/-11.7 year, male-to female ratio was 1.6:1, diabetics were 12 (21.1%), and mean follow-up duration was 39.0+/-26.4 months. Among them 30 patients (52.6%) were died. Diabetic patients had significantly lower 1 year (63.6 vs. 88.8%, p<0.05) and 3 year survival rate (19.1 vs. 62.2%, p<0.05) than non-diabetic patients. Low serum albumin(<3.5g/dl), low serum cholesterol(<130mg/dl) and low serum P (<5.0mg/dl) groups were significantly lower 1 and 3 year survival rate than high serum albumin (63.6 vs. 97.0%; 25.5 vs. 74.6%, p<0.05), cholesterol (71.4 vs. 88.0%; 38.1 vs. 60.8%, p<0.05) and p (71.9 vs. 96.3% ; 47.1 vs. 62.9%, p<0.05) groups, respectively. There were no differences in survival rate according to sex, BUN, TG, and creatinine. By Cox's proportional hazard model, low serum albumin(odds ratio 1.98), cholesterol(odds ratio 1.60), and P(odds ratio 2.09) group were independent risk factors for early death. Low serum albumin level at the start of HD maintained during the follow-up period. Cholesterol and P showed similar results. In conclusion, basal serum biochemical markers associated with visceral protein depletion such as low serum albumin, cholesterol and P seem to be early predictors of mortality in hemodialysis patients.