Study on blindness: mortality of patients with chronic kidney disease during non-elective hemodialysis

Chronic kidney disease (CKD) leads to renal failure and the need for renal replacement therapy (RRT). Secondary prevention may postpone CKD for many years. This retrospective study sought to analyze prognostic factors and estimate the mortality of patients with CKD secondary to diabetes mellitus and to hypertension that initiate RRT through non-elective hemodialysis at an emergency hospital unit in Rio de Janeiro, from hospital admission until transfer to referral units. The mortality rate was 35.1%. The study detected a significant difference between the survival curves according to disease etiology (log-rank and Peto, p=0.02) and the presence of functional arteriovenous fistulae (log-rank, p=0.0099; Peto, p=0.0090). Multivariate analysis (Cox model) revealed a 7% increase in the risk of death (p=0.002) by one-year increment in age; the presence of a functional fistule was associated to an 81% reduction in the risk of death (p=0.03). About one third of patients with CKD followed by hypertension or diabetes that initiate renal replacement therapy through non-elective hemodialysis die before being transferred to a referral unit, indicating low access to secondary prevention in CKD, including surgery for arteriovenous fistula creation.