Changing patient characteristics in chronic hemodialysis

Area of Science:

• Nephrology
• Internal Medicine
• Public Health

Background:

• Chronic hemodialysis patient demographics and clinical characteristics have evolved over time.
• Understanding these changes is crucial for optimizing renal replacement therapy.

Purpose of the Study:

• To analyze changes in patient profiles, survival rates, causes of death, and treatment outcomes in chronic hemodialysis patients over a 23-year period.
• To assess the impact of these changes on patient management and outcomes at the Karolinska Hospital.

Main Methods:

• Retrospective analysis of 274 patients accepted for chronic hemodialysis between 1965 and 1987.
• Comparison of patient demographics (age, creatinine, hemoglobin, blood pressure), co-morbidities, diagnoses, transplant rates, and causes of death over two distinct periods (before and after 1980).

Main Results:

• Mean patient age increased, while creatinine levels decreased. Co-morbidities rose, and diagnoses shifted from primary renal disease to systemic conditions like nephrosclerosis and diabetes.
• Renal transplant rates decreased. Withdrawal from dialysis and cardiovascular deaths changed significantly as causes of mortality.
• Despite sicker patients, overall mortality rates were reduced by approximately 75%.

Conclusions:

• Chronic hemodialysis patient populations have become older and more complex, with a higher burden of co-morbidities and systemic diseases.
• Significant shifts in causes of death, including increased withdrawal from dialysis and decreased cardiovascular mortality, were observed.
• Improvements in patient management and care have led to a substantial reduction in mortality rates, even with a more challenging patient profile.