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Official publication of the Indian Society of Nephrology
 
ORIGINAL ARTICLE
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Clinical profile and outcome in long-term hemodialysis: A comparative study of hospital-based versus standalone units


1 Department of Nephrology, Aster MIMS Hospital, Kozhikode, Kerala, India
2 Department of Nephrology, Aster MIMS Hospital; Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India
3 Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode; Department of Nephrology, Aster MIMS Hospital, Kottakkal, Kerala, India
4 Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode, Kerala, India
5 Department of Internal Medicine, Iqraa International Hospital and Research Centre; Daya Rehabilitation Trust, Vatakara, Kozhikode, Kerala, India
6 Department of Nephrology, Meitra Hospital, Kozhikode, Kerala, India
7 Department of Nephrology, Malabar Hospital, Kozhikode, Kerala, India
8 Department of Health Research, Iqraa International Hospital and Research Centre, Calicut, Kerala, India

Correspondence Address:
Benil Hafeeq,
Department of Nephrology, Iqraa International Hospital and Research Centre, Kozhikode, Kerala – 673009
India
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Source of Support: None, Conflict of Interest: None

DOI: 10.4103/ijn.IJN_331_20

Introduction: Chronic hemodialysis (CHD) remains the most "resorted to" renal-replacement option in India. Pursuit for accessible and affordable dialysis has resulted in setting up standalone centers (SACs). We need more Indian data on the profile of CHD population and outcome of SAC compared to hospital-based units (HBUs). Material and Methods: We analyzed the clinical profile of patients on CHD for >5 years, compared the outcome between HBU and SAC, and analyzed the factors associated with mortality. Patients initiated between January 1, 2006 and December 31, 2012 and who have survived 5 years on CHD at HBU or SAC were enrolled and followed up prospectively for 2 years. Their clinical and biochemical profile, comorbidities, long-term complications, and mortality were analyzed. Results: The study included 137 patients, 41 (30%) from HBU and 96 (70%) from SACs. In both groups, the patients were predominantly male, aged 51–70 yrs, diabetic, unplanned initiation through catheters, and had average-dialysis vintage between 83 and 85 months. SAC had more patients with hemoglobin (> 11 gm/dL) and hyperparathyroidism with elevated SAP levels (P < 0.05). Both groups had comparable iron stores, serum calcium, and phosphorus. Comparable between groups, infections, coronary artery disease, and access complications accounted for most hospitalizations and sudden cardiac death and sepsis accounted for most mortality. A trend of better survival was seen in SAC. Multivariate analysis showed anemia, DM and hospitalizations were associated with mortality. Conclusion: We conclude that the outcomes of long-term CHD at SACs are not inferior to HBUs. Anemia, diabetes, and hospitalizations were associated with overall mortality. Benefits of SACs in cost, QOL, and employment opportunities need to be studied in the Indian context.


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Indian Journal of Nephrology
Published by Wolters Kluwer - Medknow
Online since 20th Sept '07