Global and cardiovascular mortality and risk factors in patients under hemodialysis treatment.

BACKGROUND There is a high global and cardiovascular mortality rate among patients who need hemodialysis. OBJECTIVE To assess global and cardiovascular mortality and to identify the risk factors in patients who undergo hemodialysis. METHODS Observational, prospective study. A total of 334 patients were studied within three years. PRIMARY OUTCOMES global and cardiovascular mortality. Survival was assessed through Kaplan-Meier method, and the risk variables were identified by means of bivariate and multivariate Cox regression. RESULTS A total of 189 men (56.6%), aging 48.8 +/- 14.2, majority non-white (295, 88.3%) and who did finished the elementary school (211, 63.2%). Global mortality rate was 21.6%, with a 50% rate of 146-month survival; cardiovascular mortality rate was 41.7% (30/72), with a 75% rate of 141-month survival. In the bivariate analysis, the relative risk (RR) for non-cardiovascular and cardiovascular death increased when age > or =60 years old was Hb < or =9.0 g/dl and fast glycemia > or =126 mg/dl. Only non-cardiovascular death with low school grade and widow, Hb<11.0 g/dl, Ht<33.0%, fast glycemia > or =100 mg/dl, Ca product x P<42 and creatinine > or =9.2 mg/dl decreased with blood pressure (BP) > or =140/90 mmHg (before hemodialysis session) and Ht>36%; Obit due only to cardiovascular factors increased with creatinine > or =9.4 mg/dl. In the multivariate analysis, non-cardiovascular and cardiovascular RR increased with age > or =60 years old and Hb<9 g/dl; cardiovascular death RR increased with glycemia > or =126 mg/dl, and non-cardiovascular death RR increased with urea removal rate in hemodialysis (Kt/V) <1,2. CONCLUSION Global and cardiovascular mortality of patients who need hemodialysis is high. Independent risk factors for non cardiovascular and cardiovascular causes of death were age >60 years old and Hb<9 g/dl, for cardiovascular cause of death only, was fasting blood glucose > or =126 mg/dL, and for non-cardiovascular cause of death, Kt/V<1,2.