RESEARCH ARTICLE


Survival and Analysis of Predictors of Mortality in Patients Undergoing Hemodialysis in a Rural Hospital in Puducherry, India: A Retrospective Cohort Study



P. Ravi Kumar1, *, V. Vinayagmoorthy2, Amol Dongre3, Pradeep Deshmukh4
1 Department of Nephrology, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagedipeth, Puducherry, India
2 Department of Community and Family Medicine, All India Institute of Medical Sciences, Deoghar, Jharkhand, India
3 Department of Extension Programmes & Department of Community Medicine, Pramukhswami Medical College and Hospital, Karamsad, Anand, Gujarat, India
4 Department of Community Medicine, All India Institute of Medical Sciences, Nagpur, India


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Creative Commons License
© 2023 Ravi Kumar et al.

open-access license: This is an open access article distributed under the terms of the Creative Commons Attribution 4.0 International Public License (CC-BY 4.0), a copy of which is available at: https://creativecommons.org/licenses/by/4.0/legalcode. This license permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.

* Address correspondence to this author at the Department of Nephrology, Sri Manakula Vinayagar Medical College and Hospital, Kalitheerthalkuppam, Madagadipet, Puducherry, India; Tel: 011-91-995208206; E-mail: ravi.pkr@gmail.com


Abstract

Background:

Despite the advent of dialysis technology, the survival of patients on hemodialysis (HD) is not encouraging. There is little information available regarding the prognostic factors of HD, its population characteristics, or outcomes in India.

Objectives:

We attempted to describe the profile of patients on HD, estimate the mean days of their survival and to determine the various factors associated with their survival.

Materials and Methods:

It was a retrospective cohort study conducted on patients who were on maintenance HD, registered during the five-year period between 1st January 2014 and 31st December 2018 in a tertiary care teaching hospital in Rural Puducherry, South India. Demographic, hematological, biochemical, electrocardiographic, echocardiographic parameters and death during follow-up were extracted from the dialysis database after de-identification. The survival rate was calculated using Kaplan- Meir Curves and Cox Regression analysis was done to estimate the adjusted hazard ratio.

Results:

The median survival of the 229 eligible patients on HD was 819 days. Cardiac pathology accounted for 25.7% of those deaths and 33.9% was sudden death. Adjusted Cox proportional model showed the presence of Left Ventricular Hypertrophy (LVH) (HR: 78.1), increase in phosphorus (HR: 1.26), decrease in haemoglobin (HR: 0.78), and decrease in serum albumin (HR: 0.52) were significant bad prognostic factors.

Conclusion:

Screening for LVH, anemia, hypoaluminemia and hyperphosphatemia amongst HD patients and managing them to prevent these bad prognostic factors has the potential to improve their survival.

Keywords: Bio-chemical parameters, Hemodialysis, Left ventricular hypertrophy, Puducherry, Survival, Anemia, Hypoalbuminemia, Hyperphosphatemia.