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Background and Aim: The number of patients on hemodialysis (HD) increases continuously. The HD population is usually divided into early and late HD patients according to the duration of HD, that are known as incident and prevalent groups. Still, there is a debate about the exact definition of both the incident and prevalent groups. Furthermore, predictors of death of both of these groups are not yet identified, especially in Egyptian HD patients. We aimed to compare between the incident and prevalent HD patients as well as to define predictors of mortality among each of these groups.
Study Design and Methodology: This prospective multicenter study was started in June 2016, comprising 2123 HD patients recruited from twenty-five Egyptian HD centers. Patients were classified according to HD duration into two groups: Incident group including patients with HD duration equals to or less than 6 months, and a prevalent group including patients who had been maintained on HD for more than 6 months. All patients were observed for one and half years and their demographic data, laboratory findings and mortality events were recorded.
Results: In comparison to the prevalent group, the incident HD patients showed significantly lower hemoglobin, serum albumin, urea reduction ratio, serum phosphorus, and serum ferritin but higher average erythropoiesis stimulating agents (ESA) dose. There was significantly a higher number of patients with hypertension in the incident group, while there was no significant difference in diabetes mellitus or ischemic heart disease in both groups. There were a higher number of patients with positive hepatitis C virus antibodies and hyperparathyroidism in the prevalent group. By the end of the study, the mortality frequency was found to be significantly higher in the incident than the prevalent groups. Older age and corrected serum calcium were significant predictors of mortality in the total studied group as well as the prevalent group. However, no significant predictors of mortality could be detected among the incident group.
Conclusion: The incident HD group tends to show higher frequency of hypertension, laboratory findings suggestive of malnutrition as well as higher frequency of mortality with different pattern of mortality predictors compared to the prevalent group.
Nakai S, Hanafusa N, Masakane I, et al. An overview of regular dialysis treatment in Japan (as of 31 December 2012). Ther Apher Dial. 2014;18:535–602.
Kobayashi S, Keiko S, Mio U, Yoshiko T, Kosaku N. A simple protein-energy wasting score for survival prediction of maintenance hemodialysis patients. Renal Replacement Therapy. 2015;1:1.
Lukowsky LR, Kheifets L, Arah OA, Nissenson AR, Kalantar-Zadeh K. Patterns and predictors of early mortality in incident hemodialysis patients: new insights. American journal of nephrology. 2012;35(6):548-58.
Msaad R, Essadik R, Mohtadi K, et al. Predictors of mortality in hemodialysis patients. The Pan African Medical Journal. 2019;33.
Bradbury BD, Fissell RB, Albert JM, et al. Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clinical journal of the American Society of Nephrology. 2007;2(1):89-99.
Pérez-García R, Martín-Malo A, Fort J, et al. ANSWER study. Baseline characteristics of an incident haemodialysis population in Spain: results from ANSWER-a multicentre, prospective, observational cohort study. Nephrol Dial Transplant. 2009;24(2):578-88.
Kim HW, Kim SH, Kim YO, et al. The impact of high-flux dialysis on mortality rates in incident and prevalent hemodialysis patients. The Korean journal of internal medicine. 2014;29(6):774.
Varela DC, Molano-González N, Vanegas O, Rodríguez K. Quality of life in incident patients vs. prevalent patients. Is there any difference in quality of life? Revista Colombiana de Nefrología. 2017;4(2):141-8.
De Francisco AL, Kim J, Anker SD, et al. An epidemiological study of hemodialysis patients based on the European Fresenius Medical Care hemodialysis network: results of the ARO study. Nephron Clinical Practice. 2011;118(2):c143-54.
Webler JM, Port FK, Swartz RD, Ferguson CW, Williams GW, Jacobs JF Jr: Analysis of survival of end-stage renal disease patients. Kidney Int. 1982;21:78-83.
US Renal Data System (USRDS). USRDS 1990 Annual Data Report. Bethesda, MD: The National Institutes of Health, National Institute of Diabetes and Digestive and Kidney Diseases; 1990.
Soucie JM, McClellan WM. Early death in dialysis patients: Risk factors and impact on incidence and mortality rates. J Am Soc Nephrol. 1996;7:2169–2175.
Megahed AF, El-Kannishy G, Sayed-Ahmed N. Status of fasting in Ramadan of chronic hemodialysis patients all over Egypt: A multicenter observational study. Saudi J Kidney Dis Transpl. 2019;30:339-49.
Megahed AF, Abdelhady MMT, El-Kannishy G, Sayed-Ahmed N. Gender-related differences and mortality predictors among egyptian hemodialysis patients: A Multi-Center Prospective Observational Study. The Asian Journal of Medicine and Health. 2020;18(10):118-130.
Daugirdas JT, Blake PG, Ing TS. Hand book of Dialysis (5th Ed.). Faculty Bookshelf. 2015;23.
Ko YE, Yun T, Lee HA, et al. Gender-specific discrepancy in subjective global assessment for mortality in hemodialysis patients. Scientific reports. 2018;8(1):1-9.
Pedrini LA, Winter AC, Cerino F, et al. Clinical outcomes of hemodialysis patients in a public-private partnership care framework in Italy: a retrospective cohort study. BMC nephrology. 2019;20(1):35.
Libetta C, Sepe V, Esposito P, Galli F, Dal Canton A. Oxidative stress and inflammation: implications in uremia and hemodialysis. Clinical biochemistry. 2011;44(14-15):1189-98.
Fishbane, Steven, Anna T, Mathew, Rimda Wanchoo. Intravenous iron exposure and outcomes in patients on hemodialysis. Clin J Am Soc Nephrol. 2014;9(11):1837-1839.
Zepeda-Orozco D, Quigley R. Dialysis disequilibrium syndrome. Pediatric nephrology. 2012;27(12):2205-11.
Krapf R, Hulter HN. Arterial hypertension induced by erythropoietin and Erythropoiesis- Stimulating Agents (ESA). Clin J Am Soc Nephrol. 2009;4:470- 480.
Agarwal R Flynn J, Pogue V, Rahman M, Reisin E, Weir MR. Assessment and Management of Hypertension in Patients on Dialysis. Am Soc Nephrol. 2014;25(8):1630–1646.
Kalantar-Zadeh K, Kilpatrick RD, McAllister CJ, et al. Hepatitis C virus and death risk in hemodialysis patients. Journal of the American Society of Nephrology. 2007;18(5):1584-93.
Goodkin DA, Bieber B, Jadoul M, Martin P, Kanda E, Pisoni RL. Mortality, hospitalization, and quality of life among patients with hepatitis C infection on hemodialysis. Clinical Journal of the American Society of Nephrology. 2017;12(2):287-97.
Passalidou I, Karapavlidou P. Parathyroid hormone levels in hemodialysis patients. European Society of Endocrinology 12th European Congress of Endocrinology Prague. Czech Republic. 2010;24-28.
Collins AJ, Foley RN, Gilbertson DT, Chen SC. The state of chronic kidney disease, ESRD, and morbidity and mortality in the first year of dialysis. Clin J Am Soc Nephrol. 2009;4(suppl 1):S5–S11.
US Renal Data System. USRDS 2013 annual data report: atlas of chronic kidney disease and end-stage renal disease in the United States. National Institutes of Health, National Institute of Diabetes and Digestive and Digestive and Kidney Diseases. 2014;2013.
Robinson BM, Zhang J, Morgenstern H, et al. Worldwide, mortality risk is high soon after initiation of hemodialysis. Kidney international. 2014;85(1):158-65.
Zhao X, Wang M, Zuo L. Early mortality risk in incident Chinese hemodialysis patients: a retrospective cohort study. Renal failure. 2017;39(1):526-32.
Garagarza C, Valente A, Caetano C, Oliveira T, Ponce P, Silva AP. Hypophosphatemia: nutritional status, body composition, and mortality in hemodialysis patients. International Urology and Nephrology. 2017;49(7):1243-50.
Moe SM, Chen NX. Mechanisms of vascular calcification in chronic kidney disease. J Am Soc Nephrol. 2008;19:213–216.
Soleymanian T, NiCad N, Mahjoub A, Argani H, Saavaj S. Nephro-Urology Monthly: Serum Levels of Intact Parathyroid Hormone, Calcium, and Phosphorus and Risk of Mortality in Hemodialysis Patients. 2017;9(1):e42569.
Gmar-Bouraoui S, Skhiri H, Achour A, et al. The predictors of early mortality in patients starting chronic hemodialysis. Saudi Journal of Kidney Diseases and Transplantation. 2003;14(1):23.
Elsharkawy M, AbouSeif K, Sarhan I, et al. Current status of hemodialysis access in regular hemodialysis patients in Egypt (abstract); 2017.
Kim Y, Yoo KD, Kim HJ, et al. Association of serum mineral parameters with mortality in hemodialysis patients: data from the Korean end-stage renal disease registry. Kidney research and clinical practice. 2018;37(3):266.
Taniguchi M, Fukagawa M, Fujii N, et al. Committee of Renal Data Registry of the Japanese Society for Dialysis Therapy. Serum phosphate and calcium should be primarily and consistently controlled in prevalent hemodialysis patients. Therapeutic Apheresis and Dialysis. 2013;17(2):221-8.
Miller JE, Kovesdy CP, Norris KC, et al. Association of cumulatively low or high serum calcium levels with mortality in long-term hemodialysis patients. American Journal of Nephrology. 2010;32(5):403-13.
Djukanović L, Dimković N, Marinković J, et al. Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients. nefrologia. 2015;35(3):287-95.