Long-term Survival of Patients With End-stage Renal Disease on Maintenance Hemodialysis: a Multicenter Study in Iran

Abstract

Introduction. Although maintenance dialysis in patients with end-stage renal disease prevents death from uremia, patient survival remains an important issue. This study is the first in Iran to evaluate long-term survival of patients with ESRD.

Materials and Methods. This retrospective study was conducted on 1861 patients with ESRD referred to 12 hemodialysis centers in Khuzestan province, Iran. The period of study was 21 years, which was between 1989 to may 2010. The median follow-up duration was 46.0 months.  Patients who died within 90 days of commencing dialysis were excluded. The patient's death as outcome measure was recorded and the survival was estimated by the Kaplan-Meier method.

Results. The mean age of 1861 patients at initiation of hemodialysis was 51.2 ± 17.2 years, and 1120 were men (60.2%). Diabetes mellitus (32.9%) and hypertension (24.1%) were the most common known causes of ESRD in our patients. Regardless of the cause of ESRD, 1-, 5-, 10-, and 15-year survival of hemodialysis patients was 83%, 25.2%, 3.8%, and 1.0% respectively. Survival of diabetic patients was significantly lower than nondiabetic patients (P <.001) and no one of diabetic patients survived up to 10 years.

Conclusions.  Based on our findings, the survival of ESRD patients undergoing hemodialysis in Iran is relatively poor, especially among diabetics. This can be explained by socioeconomic differences and the fact that dialysis patients who are otherwise healthy and are more likely to survival for a longer time have higher chances of receiving a kidney transplant in Iran.