Marcadores predictivos de mortalidad en el primer año de hemodiálisis en el Hospital Teodoro Maldonado Carbo durante el periodo 2015-2016.

Abstract

Background: Compared to general population, patients undergoing dialysis have an increased risk of death, specially, during the first months of treatment, which is fairly explained by traditional risk factors. The role of non-traditional risk factors on all-cause mortality was assessed through inflammatory, bone mineral disease disorder and malnutrition markers. Aim: To identify markers associated with all-cause mortality during the first year of incident hemodialysis in patients secondary to intrinsic renal disease that started hemodialysis in 2015 in “Teodoro Maldonado Carbo Hospital”. Methods: Observational analytic historical cohort study. Incidence of death was assessed in terms of person per years. T-student and chi squared test were used as appropriate to establish differences among groups. To measure association between variables and all-cause mortality, univariate and multi-variate analysis were made by Cox proportional hazard model. Results: A total of 291 patients (mean, 61.9 years) started hemodialysis in HTMC in 2015. During follow-up 99 deaths occurred. Compared to the 121-365 period, patients during the first 120 days, had a higher risk for death (Relative Risk 2.73 CI 95% [1.83-4.06] p<0.05). Older age and a neutrophil-lymphocyte ratio (NLR) over 6.8 at baseline (Area under the curve by Receiver Operating Curve Analysis 0.74) were significant predictors of all-cause mortality after adjustments (HR 2.33, CI95% [1.32-4.10]; p<0.004). Patients with coronary heart disease, chronic heart failure, low albumin levels and that start dialysis with central venous catheter were associated with worst prognosis in the univariate analysis.