Compliance with guidelines and predictors of mortality in hemodialysis. Learning from Serbia patients

Objectives: The aims of the study were to determine the percentage of patients on regular hemodialysis (HD) in Serbia failing to meet KDOQI guidelines targets and find out factors associated with the risk of time to death and the association between guidelines adherence and patient outcome. Methods: A cohort of 2153 patients on regular HD in 24 centers (55.7% of overall HD population) in Serbia were followed from January 2010 to December 2012. The percentage of patients failing to meet KDOQI guidelines targets of dialysis dose (Kt/V > 1.2), hemoglobin (>110 g/L), serum phosphorus (1.1-1.8 mmol/L), calcium (2.1-2.4 mmol/L) and iPTH (150-300 pg/mL) was determined. Cox proportional hazards analysis was used to select variables significantly associated with the risk of time to death. Results: The patients were on regular HD for 5.3 +/- 5.3 years, dialyzed 11.8 +/- 1.9 h/week. Kt/V < 1.2 had 42.4% of patients, hemoglobin <110 g/L had 66.1%, s-phosphorus <1.1 mmol/L had 21.7% and >1.8 mmol/L 28.6%, s-calcium <2.1 mmol/L had 11.7% and >2.4 mmol/L 25.3%, iPTH <150 pg/mL had 40% and >300 pg/mL 39.7% of patients. Using Cox model (adjustment for patient age, gender, duration of HD treatment) age, duration of HD treatment, hemoglobin, iPTH and diabetic nephropathy were selected as significant independent predictors of time to death. When targets of five examined parameters were included in Cox model, target for KtV, hemoglobin and iPTH were found to be significant independent predictors of time to death. Conclusion: Substantial proportion of patients examined failed to meet KDOQI guidelines targets. The relative risk of time to death was associated with being outside the targets for Kt/V, hemoglobin and iPTH. (C) 2015 The Authors. Published by Elsevier Espana, S.L.U. on behalf of Sociedad Espanola de Nefrologia.