MO528INFLUENCE OF CARDIOVASCULAR DISEASES ON SURVIVAL RATES IN DIALYSIS PATIENTS IN A COHORT OF THE UZBEK POPULATION
Authors: Sharapov Olimkhon , Abdullaev Sherzod 
Published: May 2021

Abstract

Background and Aims
The mortality rate of patients on hemodialysis is 6.3-8.2 times higher than in the general population. The presence of cardiovascular comorbidity worsens the prognosis and survival in this category of patients. According to various sources, the mortality rate in patients with CVD is 3 times higher than in patients without CVD. The aim of our study was to study the effect of comorbidity of the CVD on survival in patients with end-stage CKD receiving programmed hemodialysis among the population of Uzbekistan.

Method
We conducted a multicenter prospective cohort study of 165 patients among the Uzbek population. The study took place in 3 different dialysis centers in the country for 30 months (from January 2018 to July 2020). All patients received programmed hemodialysis due to ESRD. All patients were of Uzbek nationality, there were 90 men, 75 women. The average age was 48.1 ± 14.1 years. The duration of hemodialysis at the time of inclusion of patients in the study ranged from 6 to 165 months. The main primary diseases were glomerulonephritis (46%), diabetes mellitus (27%) and urolithiasis (8%). 56% (n = 92) of patients (52 men and 40 women) had CVD and 44% (n = 73) of patients (38 men and 35 women) had no CVD. The main CVDs were hypertension, coronary heart disease, heart failure and various arrhythmias. All patients were observed during the observation period, at the end of which the outcome was noted: patients either died or continued to receive hemodialysis. The survival rate was determined using the Kaplan-Meier method. The 95% confidence interval was determined using the Greenwood method.

Results
After 30 months of follow-up, 43.6% (n = 72) of all observed patients died, 56.4% (n = 93) patients survived (of which 11 underwent kidney transplantation). The average age of the deceased (53.6 ± 1.6) was significantly higher than that of patients continuing to receive HD (45.6 ± 1.5). The average duration of hemodialysis in survivors (33.0 ± 5.4) was higher than in the dead (28.6 ± 3.9). The study of the further fate of patients, depending on the presence or absence of cardiovascular diseases, showed that among the deceased patients, 68.1% (n = 49) of patients were patients who had CVD, while among those who survived, 53.7% ( n = 44) had no CVS pathologies. Among those continuing to receive programmed hemodialysis, there were 31.7% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within the period of 30 months of prospective observation was 39.6% higher than in patients without CVD. The survival rate of patients with CVD was 0.44 [95% CI 0.34-0.55], while in patients without CVD it was 0.67 [95% CI 0.55-0.78].

Conclusion
The concomitant pathology of the cardiovascular system affects the survival rate of patients with end-stage CKD on hemodialysis. Dialysis patients of the population of Uzbekistan who do not have concomitant cardiovascular pathology have a 33% higher survival rate than patients without CVD.