Emily de Souza Ferreira [10] et al. retrospectively analyzed the survival of 422 patients who received kidney replacement therapy from January 1998 to December 2018, and the 1-year survival rate was 82.3%. Survivorship rates were slightly higher in that study than in this one. In a study of hemodialysis patients at the flagship hospital in Ho Chi Minh City [11], Vietnam, the 1-year survival rate was 85%, the 5-year survival rate was 58%, and the 10-year survival rate was 20%. The annual statistical report of the Japan Society for Dialysis Therapy shows that in 2013 [12], the 1-year survival rate was 87.6 percent, the 5-year survival rate was 59.8 percent, and the 10-year survival rate was 36.3 percent. The above studies show that survival rates for hemodialysis patients vary from country to country, which may be related to different regional economic conditions, and the figures cannot be simply compared. Our survey results are slightly lower than the basic data of our country, considering that our hospital is located in the county-level region, and the cases treated in this region are all patients with serious condition after diagnosis. In addition, we found that 3-year survival data were significantly reduced in all regions, so there is still a need to improve hemodialysis patient outcomes in terms of long-term care for long-term hemodialysis patients [13, 14].
Study has demonstrated older age, DN, higher total Charlson complication index (CCI) scores, and abnormal plasma albumin, prealbumin, and cholesterol levels may elevate the risk of death in elderly patients with ESRD [15]. Hemodialysis patients are risk factors for survival in dialysis patients. This is similar to the results of this study.The mortality rate of older adults treated with HD is reported to be two to four times higher than that of their peers [16]. The results of this study depicted that the ratio of patients ≥ 60 years old in the death group was 60.0%, significantly higher than survival group (20.4%), and the mean age in the death group was higher than that in the survival group. Consistent with the above report. Given the expanding elderly population of hemodialysis, which has also become an important risk factor for death in HD patients, clinicians must incorporate screening and treatment strategies for various elderly populations into their routine care plans and give them special attention and treatment.
Shengnan Chen [17] et al. found that in the cumulative risk curve, DN patients showed significantly faster progress to a 50% reduction in eGFR and renal replacement therapy endpoints, and DN patients progressed to 50% eGFR decline (HR: 2.30, 95% CI [1.48–3.58]) and renal replacement treatment endpoints (HR: 1.64, 95% CI [1.13–2.37]) were at higher risk, but were not among the risk factors for all-cause mortality events. This is slightly different from the results of this study, considering that it is related to the size of the sample and the different study population. In the next study, we need to expand the sample size and conduct a multi-center study, and then analyze after eliminating relevant confounding factors.
Do Hyoung Kim [18] et al. determined that in the survival analysis, compared with patients with other access, patients with arteriovenous fistula had a significantly improved survival rate and a lower frequency of hospitalization, which was consistent with the results of this study. This may be associated with the risk of infection and catheter failure caused by central vein catheters [19, 20]. Arteriovenous fistula, due to its longer patency time and fewer infection complications, suggests that the survival prognosis of patients may be improved by elevating the proportion of arteriovenous fistula in initial hemodialysis patients and maintaining the proportion of arteriovenous fistulae among patients on hemodialysis. The early establishment of reasonable vascular access will be the focus of our clinical attention. At the same time, this study also found that higher dialysis frequency can better improve dialysis adequacy, thereby prolonging the survival time of patients. One study showed a 45% reduction in mortality in the frequent (3–7 sessions/week) hemodialysis group compared to traditional hemodialysis, and the benefit was more pronounced for patients who received fewer than 5 sessions/week [21]. In a retrospective cohort research of 185 patients, they received blood therapy three times a week from 2000 to 2002, while 99 of these patients with high cardiovascular risk or high IDWG from 2003 to 2010 converted to treatment at the center every other day, and 84 patients continued to receive HD three times a week, with no significant difference in overall survival among two unbalanced groups. Because of conflicting findings on whether increased frequency of dialysis is beneficial to patients, additional research work is needed to comprehensively explore the benefit-risk ratio of these dialysis methods.