Early mortality rate in end-stage renal disease patients initiating hemodialysis

Early referral of patients with chronic renal failure (CRF) to a nephrologist improves morbidity and delays mortality after start of renal replacement therapy (RRT). Late referral is associated with increased cardiovascular morbidity and short-term mortality. The aim of this study was to assess the factors associated with early mortality rate in ESRD patients, during the first month after initiating hemodialysis. One hundred and eighty nine 189 patients hospitalized at the Department of Nephrology in Skopje after starting RRT and followed up during the first month were included in this study. Early referrals were considered those who had been referred to a nephrologist for more than 3 months before initiating RRT. Female to male ratio was 93 to 96 (49/51%). Out of them, 110 were late referrals, and 79 early ones (58/42%). Out of 189, 20 patients died during the first month of follow up (10.6%). 85% of the patients who died were late referrals, not having time and opportunity to be treated for renal anemia, for malnutrition and prevention of cardiovascular and uraemic complications, and all of them lacked permanent vascular access. Early mortality was also associated with older age, renal anemia and malnutrition. Late referrals were also older, predominantly male and had higher serum potassium levels. The main causes of death were related to uraemic intoxication, malnutrition and inflammation as well as lack of permanent vascular access, all of it leading to sepsis, and cardiovascular complications.