MO873THE STRUCTURE OF DEATH IN PATIENTS WITH ESRD ON DIALYSIS
Authors: Sharapov Olimkhon 
Published: May 2021

Abstract

Background and Aims
According to the ERA-EDTA, mortality from cardiovascular complications (CVC) among CKD patients on programmed hemodialysis (HD) is about 30 times higher than in the same age groups in the general population. More than 50% of deaths in patients with end-stage renal failure (ESRD) receiving renal replacement therapy are due to cardiovascular (CV) causes. The ratio of the remaining causes varies from country to country. In this regard, it is of interest to study the causes of death of patients with ESRD in Uzbekistan.

Method
We prospectively followed the course of 200 patients with end-stage CKD who received programmed hemodialysis in three different centers of the Republic of Uzbekistan for 24 months (from January 2018 to January 2020). All patients received hemodialysis according to the same scheme - 12 hours a week, through an arteriovenous fistula in the forearm. During this period, 72 patients died (40 men and 32 women). The average age of the deceased was 53.6 ± 1.6 years (M ± m). The main primary disease was chronic glomerulonephritis. It was 45.8% (n = 33) of all dialysis patients. Diabetes mellitus ranked second - 27.8% (n = 20). Other causes were urolithiasis - 9.7% (n = 7), pyelonephritis - 5.6% (n = 4), ADPKD - 4.2% (n = 3), vasculitis - 4.2% (n = 3 ), lupus - 2.7% (n = 2). To identify the cause of death, the medical history and the results of the pathological examination were analyzed.

Results
Among the deceased, 68.1% (n = 49) of patients had cardiovascular diseases in their medical records, while 31.9% (n = 23) did not have CVD. 43.1% (n = 31) of patients died during the first year of follow-up, the remaining 56.9% (n = 41) died within 2 years. The main cause of death of patients was sudden cardiac death, which accounted for 61.1% (n = 44) of all deaths. 18.1% (n = 13) of patients died as a result of acute respiratory failure. In 6.9% (n = 5) cases, the cause of death was acute myocardial infarction. Death due to hepatic coma and stroke accounted for 5.6% (n = 4) of patients who died. 2 (2.7%) patients died as a result of acute bleeding(figure 1).
When analyzing the structure of death of the examined patients, depending on the presence or absence of cardiovascular pathology, it was revealed that the main cause in both groups was also sudden cardiac death. But, at the same time, in patients with CVD, sudden cardiac death was 63% (n = 30) of all causes of death, while in patients without CVD, it was 59% (n = 14) the cause of all deaths. Acute respiratory failure as a cause of death was detected more in patients without CVD. 29% (n = 7) of patients died from this complication, while in patients with CVD this indicator was 13% (n = 6). All cases of acute myocardial infarction (n = 5) were observed in patients with CVD (10%). Deaths due to stroke and coma were also more common in patients with CVD(figure 2).

Conclusion
According to our study, dialysis patients with CKD die mainly due to cardiovascular accidents (more than 80%). The main place in the structure of death is taken by sudden cardiac death, which is the cause of death for more than 60% of deceased patients. Other causes were acute respiratory failure, acute myocardial infarction, coma, stroke, and acute bleeding. Patients who already had CVD more than 2 times more often die from cardiovascular complications than patients who did not have CVD.