Ljubica Djukanović1, Nada Dimković2, Jelena Marinković2, Branislav Andrić3, Jasmina Bogdanović4, Ivana Budošan5, Anica Cvetičanin6, Kosta Djordjev7, Verica Djordjević8, Živka Djurić9, Branimir Haviža Lilić10, Nasta Jovanović11, Rosa Jelačić12, Violeta Knežević13, Svetislav Kostić14, Tatjana Lazarević15, Stanimir Ljubenović14, Ivko Marić16, Rodoljub Marković17, Srboljub Milenković18, Olivera Milićević19, Igor Mitić13, Vesna Mićunović20, Milena Mišković21, Dragana Pilipović22, Steva Plješa23, Miroslava Radaković24, Marina Stojanović Stanojević25, Biserka Tirmenštajn Janković26, Goran Vojinović27, Kornelija Šefer28. 1. School of Medicine, University of Belgrade, Belgrade, Serbia. Electronic address: ljubicadjukanovic@yahoo.com. 2. School of Medicine, University of Belgrade, Belgrade, Serbia. 3. Nephrology Ward, General Hospital Krusevac, Krusevac, Serbia. 4. Nephrology Ward, General Hospital Valjevo, Valjevo, Serbia. 5. Department of Nephrology, Clinical Center of Vojvodina, Novi Sad, Serbia. 6. Nephrology Ward, Health Center Srem, Mitrovica, Srem Mitrovica, Serbia. 7. Nephrology Ward, Health Center Vrsac, Vrsac, Serbia. 8. Nephrology Ward, Health Center Smed Palanka, Smed Palanka, Serbia. 9. Department of Nephrology, Clinical Centre Zvezdara, Belgrade, Serbia. 10. Nephrology Ward, General Hospital Pirot, Pirot, Serbia. 11. Nephrology Ward, Health Centre Zagubica, Zagubica, Serbia. 12. Department of Nephrology, General Hospital Zrenjanin, Zrenjanin, Serbia. 13. Department of Nephrology, Clincal Center of Vojvodina, Novi Sad, Serbia. 14. Department of Nephrology, Clinical Center Nis, Nis, Serbia. 15. Department of Nephrology, Clinical Center of Kragujevac, Kragujevac, Serbia. 16. Department of Nephrology, Lazarevac, Serbia. 17. Department of Nephrology, Clinical Centre Zemun, Belgrade, Serbia. 18. Nephrology Ward, General Hospital, Kos Mitrovica, Serbia. 19. Nephrology Ward, Health Center Kikinda, Kikinda, Serbia. 20. Nephrology Ward, Health Center Vrbas, Vrbas, Serbia. 21. Hemodialysis Ward, Health Center Obrenovac, Obrenovac, Serbia. 22. Hemodialysis Ward, Health Center Bačka Palanka, Bačka Palanka, Serbia. 23. Clinical Center Zemun, Belgrade, Serbia. 24. Health Center Barajevo, Barajevo, Serbia. 25. General Hospital, Mladenovac, Serbia. 26. Health Center Zaječar, Zaječar, Serbia. 27. Health Center Pančevo, Pančevo, Serbia. 28. General Hospital Subotica, Subotica, Serbia.
Abstract
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 (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/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±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/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.
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 (>110g/L), serum phosphorus (1.1-1.8mmol/L), calcium (2.1-2.4mmol/L) and iPTH (150-300pg/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±1.9h/week. Kt/V<1.2 had 42.4% of patients, hemoglobin <110g/L had 66.1%, s-phosphorus <1.1mmol/L had 21.7% and >1.8mmol/L 28.6%, s-calcium <2.1mmol/L had 11.7% and >2.4mmol/L 25.3%, iPTH <150pg/mL had 40% and >300pg/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.