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Stress Is the Strongest Predictor of Death in Hemodialysis and Can Be Measured
Author(s) -
OdarCederlof I,
Kjellstrand C.
Publication year - 2003
Publication title -
hemodialysis international
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 0.658
H-Index - 47
eISSN - 1542-4758
pISSN - 1492-7535
DOI - 10.1046/j.1492-7535.2003.01219.x
Subject(s) - medicine , hemodialysis , cardiology , proportional hazards model , dialysis , hazard ratio , heart rate , blood pressure , volume overload , comorbidity , heart failure , confidence interval
The overall results of hemodialysis are not good with a 90%, 5‐year death rate in most Western countries. Several self‐evident variables: age, diagnosis, and comorbidity predict death but there are inexplicable individual variations. The usual measure of hemodialysis, “Kt/V” has been useless in predicting mortality. We speculated that it would be most important to study individual stress reactions to dialysis. We measured two important peptides measuring stress: ANP and NPY and created a stress index = (ANP + 3 × NPY). ANP reacts to the stress of fluid overload and NPY reacts to fluid overload, blood pressure and nervous overactivity. The stress index was measured in 33 patients that were followed for up to 12 years. All 12 patients (HSI) with a stress index above the mean of 275 ng/l died compared to 6/21 of patients (LSI) with an index below mean p < 0.0001. 50% survival HIS was at 29 months, compared to 116 months for LSI, p = 0.003. The following factors were correlated to the stress index:R pAge 0.4 0.026 MAP 0.5 0.005 Weight gain 0.4 0.036 Heart volume 0.4 0.010 Heart ailure 0.6 < 0.0001 Ischemic HD 0.6 < 0.0001Not correlated were albumin, Kt/V, BMI, LVH, Hgb, time on dialysis. In stepwise Cox proportional hazard analysis with all of the above factors, significant in predicting survival as co‐variates were the stress index, albumin and heart volume. Conclusions: Stress index captures the combined influence of age, fluid overload, MAP, HV, HF, IHD and is the most significant of all variables associated with death. In hemodialysis patients with a high stress index one should modify dialysis; daily, longer, and slower hemodialysis should be strongly considered. Conventional, fast three times per week is contraindicated in such patients.