Evaluation of objective and subjective indicators of death in a period of one year in a sample of prevalent patients under regular hemodialysis

The study included end-stage renal disease patients undergoing HD and analyzed demographic and laboratory data from the dialysis unit's records. Baseline data concerning socioeconomic status, comorbidity, quality of life level, coping style and depression were also assessed. For variables that differed in the comparison between survivors and non-survivors, Cox proportional hazards for death were calculated.The mortality rate was 13.0%. Non-survivors differed in age, comorbidity, inclusion on the transplant waiting list and physical functioning score. The hazard ratios of death were 8.958 (2.843-28.223; p < 0.001) for comorbidity, 3.992 (1.462-10.902; p = 0.007) for not being on the transplant waiting list, 1.038 (1.012-1.066; p = 0.005) for age, and 0.980 (0.964-0.996; p = 0.014) for physical functioning.Comorbidity, not being on the transplant waiting list, age and physical functioning, which reflects physical status, must be seen as risk indicators of death among patients undergoing HD.Fifty years ago the introduction of the Scribner shunt allowed the realization of repeated hemodialysis (HD) sessions [1]. This advance greatly extended the survival of patients suffering from end-stage renal disease (ESRD). Today there are some 80,000 ESRD patients undergoing HD in Brazil [2]. But the efficiency of dialysis treatment is limited. HD does not perform all normal kidney functions, and patients under HD retain several molecules, provoking uremic toxicity, oxidative stress and chronic inflammation [3]. The main consequence is high mortality. Mortality rates vary among HD patients throughout the world. It is low in Japan (6.6%), intermediate in Europe (15.6%) and Brazil (17.0%), and high in the United States (21.7%) [2,4]. Demographic and clinical characteristics, access to kidney transplantation and practice patterns explain the mortality differences.Age seems to be a good indicator of risk of death. In the Brazilian population, crude mortality is different according to