Korean Journal of Nephrology 1997;16(2):353-360.

혈액투석 환자에서 사망의 예측인자로서 투석 초기의 혈청 생화학적 지표의 의의

송기산 , 이으우 , 권건호 , 전정배 , 배성권 , 지동한 , 김문재

Abstract

To investigate the influence of first six-month mean for serum biochemical markers, albumin, cho- lesterol, triglyceride, inorganic phosphate, BUN, creatinine, on survival in hemodialysis, we retrospectively analyzed the 57 patients who were monitored from the start of HD for more than 6 months between January 1988 and December 1995. Exclusion criteria were as follows:' transfer to CAPD, transp- lantation or another dialysis center, HD for less than 6 months, noncompliant, death due to malignant disease, accident and self-withdrawal. The patients were divided into two groups according to the demographic characteristics and the median value of first six-month mean for serum biochemical markers. The mean age was 46.7±11.7 year, male-to fernale ratio was 1.6:1, diabetics were 12 (21.1%), and mean follow-up duration was 39.0±26.4 months. Among them 30 patients (52.6%) were died. Diabetic patients had significantly lower 1 year (63.6 vs. 88.8%, p<0.05) and 3 year survival rate (19.1 vs. 62.2%, p<0.05) than nondiabetic patients. Low serum albumin(<3.5g/dl), low serum chole- sterol(<130mg/dl) and low serum P (<5.0mg/dl) groups were significantly lower 1 and 3 year survival rate than high serum albumin (63.6 vs. 97.0%; 25.5 vs. 74.6%, p<0.05), cholesterol (71.4 vs. 88.0%; 38.1 vs. 60.8%, p<0.05) and p (71.9 vs. 96.3% ; 47.1 vs. 62.9%, p<0.05) groups, respectively. There were no differences in survival rate according to sex, BUN, TG, and creatinine. By Cox's proportional hazard model, low serum albumin(odds ratio 1.98), cholesterol(odds ratio 1.60), and P(odds ratio 2.09) group were independent risk factors for early death. Low serum albumin level at the start of HD maintained during the follow-up period. Cholesterol and P showed similar results. In conclusion, basal serum biochemical markers associated with visceral protein depletion such as low serum albumin, cholesterol and P seem to be early predictors of mortality in hemodialysis patients.