Document Detail

Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload.
MedLine Citation:
PMID:  17942779     Owner:  NLM     Status:  MEDLINE    
BACKGROUND AND OBJECTIVES: Mortality in patients who are on maintenance hemodialysis and have congestive heart failure is high in small cohort studies. The aim of this study was to determine long-term survival in a large cohort of dialysis patients with congestive heart failure and suspected fluid overload or pulmonary edema. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS: Data were analyzed, retrospectively, on 1,119,808 patients who started hemodialysis between January 1977 and December 1999. Survival was estimated from the first (index) hospital admission with congestive heart failure, fluid overload, or pulmonary edema, after 60 d of successful hemodialysis using the life-table method. The impact of patient characteristics on outcome was assessed by the Cox proportional hazards model. RESULTS: Of the 310,456 patients included in the study, 233,454 were admitted with congestive heart failure, 63,886 with fluid overload, and 13,116 with pulmonary edema. The patients with congestive heart failure were older and often white and had diabetes or hypertension as the cause of renal failure. Deaths during the index hospital admission were 8.7% for congestive heart failure, 4.0% for fluid overload, and 6.6% for pulmonary edema. Five-year survival was 12.5, 20.2, and 21.3%, respectively. The independent positive predictors for mortality in these patients were age, male gender, diabetes, hypertension, history of cardiovascular disease, and congestive heart failure. CONCLUSIONS: This study demonstrates very poor survival in dialysis patients who present with congestive heart failure, pulmonary edema, or fluid overload compared with patients who present with congestive heart failure without renal failure. Meticulous management of cardiovascular risk should improve survival.
Debasish Banerjee; Jennie Z Ma; Allan J Collins; Charles A Herzog
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Publication Detail:
Type:  Journal Article; Research Support, N.I.H., Extramural     Date:  2007-10-17
Journal Detail:
Title:  Clinical journal of the American Society of Nephrology : CJASN     Volume:  2     ISSN:  1555-905X     ISO Abbreviation:  -     Publication Date:  2007 Nov 
Date Detail:
Created Date:  2007-10-26     Completed Date:  2007-11-20     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  101271570     Medline TA:  Clin J Am Soc Nephrol     Country:  United States    
Other Details:
Languages:  eng     Pagination:  1186-90     Citation Subset:  IM    
Renal and Transplantation Unit, St. George's Hospital NHS Trust, Tooting, London, UK, SW17 0QT.
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MeSH Terms
Heart Failure / mortality*
Middle Aged
Pulmonary Edema / mortality*
Renal Dialysis / mortality*
Retrospective Studies
Water-Electrolyte Imbalance / mortality*
Grant Support
HHSN267200715003C//PHS HHS

From MEDLINE®/PubMed®, a database of the U.S. National Library of Medicine

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