Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment.

Autor:	Almeida FA; Escola Bahiana de Medicina e Saúde Pública, BA, Brasil., Machado FC, Moura JA Jr, Guimarães AC
Jazyk:	English; Portuguese; Spanish; Castilian
Zdroj:	Arquivos brasileiros de cardiologia [Arq Bras Cardiol] 2010 Feb; Vol. 94 (2), pp. 187-92, 201-6, 190-5.
DOI:	10.1590/s0066-782x2010005000003
Abstrakt:	Background: There is a high global and cardiovascular mortality rate among patients who need hemodialysis. Objective: To assess global and cardiovascular mortality and to identify the risk factors in patients who undergo hemodialysis. Methods: Observational, prospective study. A total of 334 patients were studied within three years. Primary Outcomes: global and cardiovascular mortality. Survival was assessed through Kaplan-Meier method, and the risk variables were identified by means of bivariate and multivariate Cox regression. Results: A total of 189 men (56.6%), aging 48.8 +/- 14.2, majority non-white (295, 88.3%) and who did finished the elementary school (211, 63.2%). Global mortality rate was 21.6%, with a 50% rate of 146-month survival; cardiovascular mortality rate was 41.7% (30/72), with a 75% rate of 141-month survival. In the bivariate analysis, the relative risk (RR) for non-cardiovascular and cardiovascular death increased when age > or =60 years old was Hb < or =9.0 g/dl and fast glycemia > or =126 mg/dl. Only non-cardiovascular death with low school grade and widow, Hb<11.0 g/dl, Ht<33.0%, fast glycemia > or =100 mg/dl, Ca product x P<42 and creatinine > or =9.2 mg/dl decreased with blood pressure (BP) > or =140/90 mmHg (before hemodialysis session) and Ht>36%; Obit due only to cardiovascular factors increased with creatinine > or =9.4 mg/dl. In the multivariate analysis, non-cardiovascular and cardiovascular RR increased with age > or =60 years old and Hb<9 g/dl; cardiovascular death RR increased with glycemia > or =126 mg/dl, and non-cardiovascular death RR increased with urea removal rate in hemodialysis (Kt/V) <1,2. Conclusion: Global and cardiovascular mortality of patients who need hemodialysis is high. Independent risk factors for non cardiovascular and cardiovascular causes of death were age >60 years old and Hb<9 g/dl, for cardiovascular cause of death only, was fasting blood glucose > or =126 mg/dL, and for non-cardiovascular cause of death, Kt/V<1,2.
Databáze:	MEDLINE
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