P104
DETERMINANTS OF SURVIVAL IN ADULT DIALYSIS PATIENTS IN LIBYA
Alashek, W1, McIntyre, C1,2, Taal, M2
1
School of Graduate Entry Medicine, University of Nottingham, 2Department of Renal Medicine, Derby
Hospitals NHS Foundation Trust
INTRODUCTION: Maintenance dialysis sustains life for more than one million patients worldwide but is
associated with substantially reduced survival when compared to the general population. Patient survival is an
important outcome measure for dialysis because it is influenced by the quality of dialysis services. In Libya
free access to dialysis has been provided for four decades but information about the outcomes of dialysis
patients has not previously been published. A renal registry and national clinical practice guidelines for
dialysis have not yet been established. This study therefore aimed to provide the first analysis of survival in
Libyan dialysis patients.
METHODS: This prospective multicentre, observational cohort included all patients in Libya who had been
receiving dialysis for >90 days in June 2009. Socio-demographic and clinical data were collected upon
enrolment using a structured data collection form. Survival status after 1 year was determined for all patients
except those censored due to renal transplantation or lost to follow-up due to transfer to another dialysis unit.
RESULTS: 2273 patients were enrolled for this study with a mean age of 48.7±15.5 years. Of these 67
received a kidney transplant, 46 were transferred to another dialysis unit where their status could not be
confirmed and 1 recovered renal function. Thus 2159 patients were successfully followed up for 1 year. 458
deaths occurred, giving a crude annual mortality rate of 21.2%. 138 (30.1%) deaths were due to ischaemic
heart disease, 73 (15.9%) due to cerebrovascular accidents and 74 (16.2%) due to infection. In 23% of cases,
the cause of death was not determined. Annual mortality rate ranged from 0-70% in different dialysis centres.
The best survival was in the age group 25-34 years. The mean age of those who survived was 9 years less than
those who died. Those who survived had longer duration on dialysis, lower predialysis systolic blood
pressure, more time on haemodialysis each week, higher haemoglobin and lower predialysis urea. A positive
association was found between risk of death and diabetes, past history of cerebrovascular accidents, physical
dependency and unplanned initiation of dialysis. Binary logistic regression analysis identified age at onset of
dialysis, physical dependency, diabetes and predialysis urea as independent determinants of increased
mortality (Table 1).
Table 1: Independent risk factors for increased 1-year mortality in dialysis patients
HR
95.0% CI
P- value
Age at onset (years)
1.037
1.027-1.047
<0.0001
Physically dependent
1.700
1.253-2.307
<0.0001
Diabetes
1.482
1.087-2.021
0.013
Predialysis urea
1.004
1.002-1.007
0.002
Hosmer and Lemeshow test of goodness of fit P- value =0.999; Nagelkerke R Squared=0.159
CONCLUSION: Patients receiving dialysis in Libya have a crude 1-year mortality rate similar to western
countries but the mean age of the dialysis population is much lower than that in most western countries. As in
most countries, cardiovascular disease was the most common cause of death, but infection was also an
important cause. The large variation in mortality rates between different centres suggests that survival could
be improved by transferring best practice from those centres with the best outcomes to those with poor
survival.
1