5-18
MORTALITY RISK FACTORS: 3 YEARS MORTALITY AFTER FIRST HOSPITALIZATION IN HEMODIALYSIS PATIENTS TREATED IN SOETOMO-HOSPITAL, SURABAYA-INDONESIA
Djoko Santoso 1 , Moh. Yogiantoro1, Pranawa 1 , Yasuhiko Tomino2
1.Division of Nephrology - Hypertension, Department of Internal Medicine, Dr.Soetomo Hospital, Faculty of Medicine, Airlangga University - Surabaya, Indonesia. 2. Division of Nephrology, Department of Internal Medicine, Juntendo University, Tokyo, Japan

Background.
The mortality rates of End-Stage Renal Disease (ESRD) patients remain high and always associated to the supposed risk factors, such as diabetes Mellitus, elevated systolic-diastolic blood pressure, and albumin. However, there have been lack of epidemiological evidence reported in Indonesia on which factors are dominant to the high rate of mortality.

Objective.
To identify the relationship between the supposed risk factors and the high rate of mortality.

Material-method.
Design: retrospective cohort study. This study involved 571 patients (373 males and 148 females) in a single centre. The data were firstly collected in 2000 and evaluated in the following year and the evaluation continued up to the next two years. In other words, the numbers of ESRD patients in their initial hospitalisation were recorded and evaluated every year up to 3 years. The data were collected totally four times i.e: from 2000 to 2003, the evaluation was completed in 2006. The average age of patients in the initial admission is 49.04 years old. The samples comprised patients with DM and Non-DM. Demographic data were recorded at enrollment with minimum of one hospital admission. Patients with the record of transfer from another hospital were excluded from criteria. The supposed risk factors for mortality were: age, sex, elevated systolic and diastolic blood pressure, low albumin and hematocrit, elevated cholesterol, triglycerides, uric acid, urea, serum creatinin, K, Ca, P.

Results.
There were 571 hemodialysis patients between 2000 and 2003. The crude annual mortality rate in our centre was 28.4% in all hemodialysis patients (range 25.5-29.7%). After adjustment, only elevated systole and diastolic blood pressure, as well as low albumin contributed the over mortality of ESRD patients (2.64; 95% confidence interval, 1.36 to 5.14; P=0.008, 2.22; 95% confidence interval, 1.21-4.05; P=0.028, 2.13; 95% confidence interval, 1.28-3.54, P=0.001 respectively). Surprisingly, some supposed factors which were thought to contribute the over mortality did not significantly influence the mortality rate in our centre. They were age, sex, diabetes mellitus, cholesterol, triglycerides, uric acid, urea and anemia. Further, the quantity of dialysis weekly twice did not show better outcomes than once.

Conclusion.
The high rate of mortality was found in our study. Further, the risk factors of high rate of mortality numbered only 3 out of 14, i.e. elevated systolic, diastolic blood pressure, low albumin. The other 11 factors did not significantly contribute the high mortality rate.

<back>