IMPACT OF THE INITIAL LEVELS OF LABORATORY VARIABLES ON SURVIVAL IN CHRONIC DIALYSIS PATIENTS

Besides the age at start of dialysis and the presence of diabetes mell itus, serum albumin has been shown to be a significant predictor of su rvival in prevalent dialysis patients. However, this was not evaluated in incipient dialysis patients. The initial biochemical variables wer e retrieved for a large dialysis population (N = 1,982) who were start ed on chronic dialysis in Okinawa, Japan from 1971 to 1990. Biochemica l data that included blood urea nitrogen, serum creatinine, serum elec trolytes (sodium, potassium, calcium, and phosphate), total cholestero l, triglyceride, total protein, serum albumin, and hematocrit obtained just before the first dialysis session were available for 1,491 (75.2 %) patients. Six hundred sixty-four (43.2%) patients died by the end o f 1993. Cox propertional analysis adjusted for sex, age, year of start of dialysis, presence of diabetes mellitus, and the laboratory variab les was performed to examine the significance of the initial biochemic al data on survival. The risk ratio was 0.577 (P = 0.0025) in serum al bumin, 1.291 (P = 0.0138) in serum potassium, and 0.966 (P = 0.0202) i n serum sodium. The study results support the notion that nutritional status is important for survival in chronic dialysis patients. Causes of hypoalbuminemia, hyperkalemia, and hyponatremia should be evaluated carefully at initiation of dialysis. (C) 1996 by the National Kidney Foundation, Inc.