%0 Journal Article
%T Risk Factors for Mortality in Hemodialysis Patients: Two-Year Follow-Up Study
%A Maria do Sameiro-Faria
%A Sandra Ribeiro
%A El¨ªsio Costa
%A Denisa Mendon£¿a
%A Laetitia Teixeira
%A Petronila Rocha-Pereira
%A Jo£¿o Fernandes
%A Henrique Nascimento
%A Michaela Kohlova
%A Fl¨¢vio Reis
%A Leonilde Amado
%A Elsa Bronze-da-Rocha
%A Vasco Miranda
%A Alexandre Quintanilha
%A Lu¨ªs Belo
%A Alice Santos-Silva
%J Disease Markers
%D 2013
%R 10.1155/2013/518945
%X Background. End-stage renal disease (ESRD) patients under hemodialysis (HD) have high mortality rate. Inflammation, dyslipidemia, disturbances in erythropoiesis, iron metabolism, endothelial function, and nutritional status have been reported in these patients. Our aim was to identify any significant association of death with these disturbances, by performing a two-year follow-up study. Methods and Results. A large set of data was obtained from 189 HD patients (55.0% male; 66.4 ¡À 13.9 years old), including hematological data, lipid profile, iron metabolism, nutritional, inflammatory, and endothelial (dys)function markers, and dialysis adequacy. Results. 35 patients (18.5%) died along the follow-up period. Our data showed that the type of vascular access, C-reactive protein (CRP), and triglycerides (TG) are significant predictors of death. The risk of death was higher in patients using central venous catheter (CVC) (Hazard ratio [HR] =3.03, 95% CI = 1.49¨C6.13), with higher CRP levels (fourth quartile), compared with those with lower levels (first quartile) (HR = 17.3, 95% CI = 2.40¨C124.9). Patients with higher TG levels (fourth quartile) presented a lower risk of death, compared with those with the lower TG levels (first quartile) (HR = 0.18, 95% CI = 0.05¨C0.58). Conclusions. The use of CVC, high CRP, and low TG values seem to be independent risk factors for mortality in HD patients. 1. Introduction Patients with end-stage renal disease (ESRD) have a high mortality rate [1, 2] that far exceeds the mortality rate for the non-ESRD population [3]. In the past half-century, the widespread use of hemodialysis (HD) to prolong life of ESRD patients has been a remarkable achievement, preventing death from uremia in these patients. Nowadays this therapy has expanded widely and is being used by an increasing elderly patient population, leading to significant economic consequences to patients and to healthcare systems. Our present knowledge of the mechanisms leading to increased death in this context is incomplete. In the last years, this medical field has known significant technological and pharmacological improvements. Although some evidence may suggest that mortality rate among dialysis patients has decreased over the last few years, actually, patient¡¯s survival is still low. Cardiovascular disease (CVD) has been considered the most common cause of death in these patients [4]. Cardiac arrest and congestive heart failure are more prominent causes of cardiovascular death than acute myocardial infarction in patients with uremia. A higher mortality rate within the
%U http://www.hindawi.com/journals/dm/2013/518945/