Identifying key prognostic indicators for extended hemodialysis survival: A comprehensive analysis of clinical, laboratory, and demographic factors

Abstract

Objectives: Although maintenance dialysis prevents death from uremia, mortality among patients with end-stage kidney disease-ESKD remains high. Hence, this study aims to detect the demographic, clinical, and laboratory parameters that contribute to long-term survival on hemodialysis-HD. Material and Methods: We conducted a retrospective case-control comparative study based on a single-center experience involving patients on regular HD aged 18 years and older at ASSEEB RDC, the second-largest dialysis center in Oman (serving over 200 patients). The study compares the demographic, laboratory, and clinical data of patients with short-term survival on HD (<10 years) versus long-term survival (>10 years). Both groups consisted of an equal number of patients ( n =34 each). Results: Most patients with HD are middle-aged (24-64 years). In the long-term survival group, the gender distribution was equal, whereas males were more prominent than females in the short-term survival group (67% versus 32%). Diabetic nephropathy was the primary cause of ESKD in our study population (88% in both groups). Hypertension-HTN and ischemic heart disease-IHD were more prevalent in the short-term survival group than in the long-term survival group (82% and 23% versus 29% and 6%, respectively, p <0.001 for HTN). The use of permanent catheters was more common in short-term survival patients compared to long-term survival patients (17% versus 8%). A significant proportion of the long-term survival group had higher education or postgraduate degrees (50%), whereas none in the short-term survival group did ( p <0.001). Smoking was more prevalent in the short-term survival group (17.6%) compared to the long-term survival group (5.8%). Furthermore, patients with long-term survival on HD demonstrated better dialysis adequacy (70%), iron levels (transferrin saturation 38%), serum albumin (40 mg/dL), fasting blood sugar levels (6.5 mmol/L), hemoglobin, and white blood cell counts than patients with short-term survival. Conclusion: The present study identifies that elevated values of serum iron, serum albumin, and urea reduction rate (indicating good dialysis adequacy), along with optimal blood sugar levels, fewer comorbidities (such as hypertension and ischemic heart disease combined with diabetes mellitus), a high level of education, and a lower incidence of smoking, serve as useful prognostic factors for extended survival time in the HD population.