La supervivencia de las personas sometidas a diálisis

Abstract

Survival of patients with chronic kidney disease who begin renal replacement therapy is a problem to be solved because despite the advances in nephrological care since the second half of the last century, their life expectancy is very short compared to the general population^1,2. Although there are notable differences in morbimortality from one country to another, even among advanced health care countries and despite technical advances in hemodialysis, in recent years there has been very little improvement in survival due to, among other factors, the increasing age and comorbidity of these patients. Large prospective observational studies, such as the Dialysis Outcomes and Practice Patterns Study (DOPPS)³ or population-based studies such as the United States Renal Data System Dialysis Morbidity and Mortality Wave 24, have provided very valuable information on the significance of certain factors in patient morbidity and mortality⁵. In Spain, in addition to registries such as the GREG, there are also prospective epidemiological studies^6,7 which have provided very conclusive data regarding the results, and which also suggest areas for improvement. The methodology of these studies is very important when assessing their results but, in both population-based and prospective registries, it is clear that in addition to age, there are other characteristics inherent in patients or related to the practice of hemodialysis that influence their survival8. Although cardiovascular causes as a whole and infections are the most frequent causes in all series, roughly speaking and taking into account general data, mortality of these patients can be estimated at 14% while survival at 5 years is close to 56%. The studies cited suggest that these results can be improved by increasing dialysis time, applying connective techniques or using internal arteriovenous fistula as the vascular access of choice^6,7. As well as agreeing on these results, different authors have gone into more detail on specific aspects that have also been shown to be significant in relation to this issue.