Outcome of patients on haemodialysis in Khuzestan, Iran

Sir The prevalence and incidence rate of patients treated for end-stage renal disease (ESRD) undergoing haemodialysis is increasing in Iran, from 98 and 38.2 pmp to 169 and 66 pmp in 2004, respectively [1, 2]. Although many studies on the survival of patients with ESRD have been done in developed countries, lack of data from developing countries still exists. This epidemiologic retrospective study was conducted in patients with ESRD referred to nine haemodialysis centres in Khuzestan province of Iran. The period of study was 15 years, started in 1994 and finished in 2009. Haemodialysis was performed for 9–12 h, three times a week, using semisynthetic (cellulose diacetate) or synthetic (polysulphone) dialysis membranes. Acetate-based dialysis solution was used till January 2006 and bicarbonate-based dialysis solution, thereafter, at a delivered bicarbonate concentration of 35 mEq/L. We included only patients with ESRD on maintenance haemodialysis treatment, who were dialysed >90 days before entering the study. Patients who died within the first 90 days of commencing dialysis were excluded. Other exclusion criteria were incomplete data of patients, haemodialysis because of acute renal failure, kidney transplantation or peritoneal dialysis as renal replacement therapy at any time of study. The study was carried out under the approval of Ahvaz Jundishapur University of Medical Sciences Ethical Committee. Over a 15-year period follow-up, overall 1312 patients with ESRD underwent haemodialysis in nine haemodialysis centres. After exclusion, data were analysed of 846 patients, 467 (55.2%) were male and 379 were female (44.8%). At the start of haemodialysis, the mean age of all patients was 51.8 17.0 years (range, 6–90 years). The survival analysis was performed in 846 patients. The mean and median follow-up duration were 32.7 and 23.0 months, respectively. The mean patient survival at the end of 1 year was 10.6 months [95% confidence interval (CI): 10.4–10.8], 23.4 months (95% CI: 22.4–24.4) at 3 years, 28.2 months (95% CI: 26.4–30.0) at 5 years, 27.8 months (95% CI: 25.4–29.8) at 7 years and 26.8 months (95% CI: 24.4–29.2) at 10 years of follow-up. Table 1 and Figure 1 show the survival of patients according to diabetic status.