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Arch Iran Med. 2021;24(11): 828-836.
doi: 10.34172/aim.2021.123
  Abstract View: 834
  PDF Download: 445

Original Article

Prognosis and Long-Term Overall Survival in Hypertensive Patients Undergoing Chronic Hemodialysis: A Multicenter Parametric Mixture Split-Population Analysis

Vahid Ebrahimi 1 ORCID logo, Mehrdad Sharifi 2,3 ORCID logo, Mohammad Hossein Khademian 4, Peyman Jafari 1, Shahrokh Ezzatzadegan Jahromi 5, Samaneh Sabouri 1* ORCID logo

1 Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
2 Emergency Medicine Department, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran
3 Emergency Medicine Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
4 Department of Medical Surgical Nursing, School of Nursing and Midwifery, Shiraz University of Medical Sciences, Shiraz, Iran
5 Department of Medicine, School of Medicine, Nephrology Urology Research Center, Shiraz University of Medical Sciences, Shiraz, Iran
*Corresponding Author: *Corresponding Author: Samaneh Sabouri, PhD; Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Zand Street, Shiraz, Iran. Tel: +98- 7132084301; Fax: +98-7132349330; E-mail: , Email: samaneh_sabouri@yahoo.com

Abstract

Background: Hemodialysis (HD) patients face long-term complications which require ongoing dialysis and follow-up. The management of hypertension among HD populations has often been neglected. This study aimed at identifying the determinants of death in hypertensive HD (HTN-HD) patients.

Methods: In a multicenter retrospective cohort study (conducted from 2005 to 2018 in thirty-four HD centers affiliated with Shiraz University of Medical Sciences), the data of 725 HTN-HD patients who had at least 3 months of regular dialysis and follow-up were analyzed. Accelerated failure time mixture split-population (AFTMSP) regression was utilized to identify the factors with significant effects on long- and short-term overall survival (OS) separately.

Results: Among the different AFTMSP models, the extended generalized gamma (EGG) model outperformed the others. Sex (male: event time ratio [ETR]=1.30), initial vascular access type (arteriovenous fistula: ETR=1.50), and the type of membrane flux used for HD (high-flux: ETR=1.27) had important impacts on short-term OS. Moreover, age (OR=1.06), dialysis adequacy (Kt/ Vurea≤1.2: OR=2.30), initial vascular access type (central venous catheter: OR=2.08), serum sodium (OR=0.90) concentration, and potassium (OR=0.66) concentration had significant effects on long-term OS.

Conclusion: The split-population analyses were able to demonstrate that the predictors of long-term OS were different from those of short-term OS. Although the superiority of the parametric EGG model was proved in this study, further research with different databases is suggested. Moreover, these findings can be considered by health policy decision-makers to create a new guideline to enhance the long-term OS of HTN-HD patients.



Cite this article as: Ebrahimi V, Sharifi M, Khademian MH, Jafari P, Ezzatzadegan Jahromi S, Sabouri S. Prognosis and long-term overall survival in hypertensive patients undergoing chronic hemodialysis: a multicenter parametric mixture split-population analysis. Arch Iran Med. 2021;24(11):828-836. doi: 10.34172/aim.2021.123
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Abstract View: 835

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PDF Download: 445

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Submitted: 12 Nov 2020
Revision: 30 Jan 2021
Accepted: 07 Feb 2021
ePublished: 01 Nov 2021
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