Outcomes in Incident Hemodialysis Patients in One Center: Results from 15 Years Cohort Study

Aim: While mortality among hemodialysis patients has been well researched in Western countries, only few systematic studies have been reported from China. The aim of this study was explore outcome in chronic hemodialysis patients in an academic Chinese hospital. Methods: We extracted data from consecutive incident patients who initiated hemodialysis and survived at least 90 days between 1/1/1998 and 31/12/2012 in the Renji hospital, Shanghai, China. The follow-up period ended on 30/6/2014. We used Kaplan Meier and Cox proportional hazards analysis to explore survival characteristics and associated covariates. Results: Out of 646 patients who started dialysis, 522 patients had a documented survival beyond 90 days. Their median age at dialysis initiation was 55.3 years (range 15.4-89.6), 322 patients (61.7%) were males. By 30/6/2014, 172 patients (33%) had died, 253 (48.5%) were alive on hemodialysis, 60 patients (11.5%) were transplanted, 35 (6.7%) transferred to another center, and 1 patient each switched to peritoneal dialysis and recovered kidney function. Fiveyear and ten-year survival rates were 74.2% and 53.6%, respectively. Age at dialysis initiation (hazard ratio 1.053, 95% CI [1.039, 1.266], p<0.001) and diabetic nephropathy (HR 1.73, 95% CI [1.046, 2.081], p<0.033) were associated with increased mortality. Conclusion: Our findings indicated a comparably low 5- and 10-year mortality in patients who had a documented survival beyond the first 90 days. This finding may in part be due to the lower age at dialysis initiation and the low prevalence of diabetes in the study population.