The cause of death of chronic renal failure patients before renal replacement therapy

Choi, Shin; Park, Won Do

Abstract

BACKGROUND: Long-term survival rate of chronic renal failure patients has been increasing gradually since the development of renal replacement therapy. At present, death cause of patients under the renal replacement therapy is well known, however, there is few clinical research on that of patients before starting the therapy and the referral time to a nephrologist. We have analyzed the death cause of patients before starting the renal replacement therapy and to investigate if the death has associated with the referral time to a nephrologist.
METHODS
We investigated chronic renal failure patients who had been admitted Sanggye Paik Hospital from January 1997 to December 2000. Specific target was the deceased among the chronic renal failure patients who had not undergone renal replacement therapy. Our research was done in a retrograde study. We divided the target group into diabetic group and non-diabetic group.
RESULTS
Among 29 expired patients, male patients were 17 and female were 12, and their average age was 61+/-12.3 years. As the cause of chronic renal failure, diabetes was 15, hypertension was 8, glomerular disease was 4, and unidentified was 2. Diabetic group were 15(51.7%) and non-diabetic group were 14(48.3%). Average age was 57.3+/-9.5 years in the diabetic group and 58.9+/-10.2 years in the non-diabetic group. The rate of male and female was 9:6 in the diabetic group and 8:6 in the non-diabetic group, so the rate seems similar in both of groups. BUN and creatinine in blood was compared at the hospital admission, the diabetic group had an average BUN of 54.3+/-12.4 mg/dL and average creatinine of 7.1+/- 2.5 mg/dL and the non-diabetic group had an average BUN 98.9+/-10.6 mg/dL and average creatinine of 9.3+/-3.0 mg/dL. Albumin in blood was 3.4+/-0.6g/dL in the diabetic and 3.6+/-0.8g/dL in the non-diabetic. As the death cause, sepsis was 17(58.6%), cardiovascular disease 5(17.5%), intracranial hemorrhage 4(13.8%), and liver disease was 3(10.1%). As the cause of sepsis, pneumonia was 9(52.9%), catheter infection 5(29.4%), peritoneum 2(11.7%) and urinary track infection was 1(6.0%). The initial meeting with a nephrologist prior to dialysis occurred as follow; in the diabetic group, early refer was 4(26.6%) and delay refer was 11(73.4%), and in the non-diabetic early refer was 2(14.2%) and delay refer was 12(85.8%).
CONCLUSION
As for chronic renal failure patients before starting the renal replacement therapy, a physician should give an continual attention to the patients and refer them to a nephrologist promptly for the renal replacement therapy. In addition, a nephrologist should not lose the time for dialysis by analyzing the patient's condition thoroughly and starting the renal replacement therapy at the opportune moment, which could be helpful to reduce patients' medical expense and death rate.