Predicting early mortality in incident hemodialysis patients: strengthening a shared decision-making process

• Autor(a) principal: Belino,Carolina L
• Data de Publicação: 2017
• Outros Autores: Coelho,Augusto M, Pereira,Susana J, Lopes,Daniela M, Silva,C, Gomes,Ana M, Ventura,Ana M
• Tipo de documento: Artigo
• Idioma: eng
• Título da fonte: Repositório Científico de Acesso Aberto de Portugal (Repositórios Cientìficos)
• Texto Completo: http://scielo.pt/scielo.php?script=sci_arttext&pid=S0872-01692017000400004
• topic: elderly; conservative care; mortality risk factors; prognostic tools

Introduction: The benefits of dialysis in the elderly are dubious. A shared decision-making process, helped by adequate prognostic tools, is essential to determine which patients are better candidates for conservative care. Based on a recent USRDS validated score, this study aimed to identify risk factors associated with early mortality (first 90 days) in a Portuguese cohort of patients. Methods: A total of 197 patients who initiated hemodialysis treatments in a Portuguese facility between 2005 and 2015 were included. Clinical and laboratory data were collected at time of admission to center. Multiple regression models were performed and fitted to identify potential predictors of early mortality. Findings: Total of 93 (47.2%) deaths with 23 (11.7%) deaths occurring in first year. In the first three months, there were 15 (7.6%) deaths. Of those who died in first three months, most were men (n=10; 5.1%), mean age 73.5 ± 6.82 years. Almost half (n=7; 3.6%) were dependent and the majority (n=12; 6.1%) had history of hospitalizations in previous year before admission. They had a higher prevalence of hypoalbuminemia and cardiovascular risk factors. Mortality associated factors were albumin level low (<3.5 g/dL) or unknown (OR 5.73; p<0.05), ischemic cardiomyopathy (OR 4; p<0.05) and history of hospitalizations in previous year before admission (OR 4.3; p<0.05). Absence of history hypertension was associated with a reduction of risk (OR 0, 18, p<0.05). Discussion: Some elements of USRDS score were associated with greater risk for early mortality in this Portuguese cohort of patients. Further investigations are needed in order to validate a specific prognostic tool in Europeans