Abstract:

Objective To evaluate the relationship between the residual renal function before hemodialysis and the long-term prognosis of patients who undergo hemodialysis. Methods Data of adult patients with the end-stage renal disease (ESRD) who underwent the maintenance hemodialysis between January, 2005 and September, 2013 was collected. Patients were followed up till March 31, 2014. According to the estimated glomerular filtration rate (eGFR) before hemodialysis, patients were divided into four groups and their eGFRs were ≥10.5, 8.1-10.4, 6-8, and <6 mL·min^-1·(1.73 m²)^-1, respectively. The simplified equation of modification of diet in renal disease (MDRD) was adopted to evaluate the eGFR. The endpoint event was all-cause mortality. Results The median eGFR of 294 patients before hemodialysis was 5.43 (2.27-13.92) mL·min^-1·(1.73 m²)^-1. A total of 65 patients died during the period of follow-up and the top three causes of death were cerebrovascular accidents, infections, and cardiovascular diseases. With the decrease of eGFR after hemodialysis, blood urea nitrogen, serum creatinine, serum uric acid, phosphorus, calcium and phosphate product, serum ferritin, proportion of hyperuricacidemia complication, and proportion of Charlson combidity indexes (CCI) between 0-2 gradually increased and proportion of diabetes, hematocrit, and proportion of CCI≥5 gradually decreased. The multivariate Cox regression analysis indicated that the serum creatinine was a protective factor of long term prognosis of patients who underwent the hemodialysis and CCI, combined cerebrovascluar diseases, combined chronic obstructive pulmonary disease, emergent hemodialysis due to other reasons, and triglyceride were risk factors. The stratified analysis was performed for the emergency hemodialysis group, selecting hemodialysis group, albumin <35 g/L group, albumin ≥35 g/L group, age <65 years group, and age ≥65 years group. The results showed that the long-term prognosis of patients with high eGFRs before hemodialysis was not better. Conclusion Although the incidences of anemia, hyperuricacidemia, and calcium and phosphorus metabolism disorder of patients with low eGFRs before hemodialysis are more than those of patients with high eGFRs, the long-term prognosis of patients with high eGFRs before hemodialysis is not better. There is no significant relationship between the eGFR before hemodialysis and the long term prognosis.

Key words: residual renal function at the start of dialysis, end-stage renal disease, hemodialysis prognosis