HEALTH FUNDER AS A PREDICTOR OF MORTALITY IN HEMODIALYSIS AT A SINGLE CENTER IN ARGENTINA

Abstract

Introduction: Several factors influence mortality in dialysis patients; however, the influence of the healthcare system on survival in this group is unknown. We aimed to assess the influence of the healthcare system on end-stage renal disease patients starting hemodialysis and its impact on mortality. Materials and Methods: We evaluated 503 patients admitted to hemodialysis at CEMIC between January 1995 and June 2020. Considering the healthcare system, the patients were divided into two groups: private (PHC n=360) and government (GHC n=143). Results: The median follow-up time was 30.9 months (12.9-50). In the GHC group, patients were older (66.5 vs. 58.8 years p<0.0001), admitted with a lower percentage of AVF/prosthesis (44.1 vs. 55.3% p < 0.029), phosphorus (5.5 vs. 6 mg /dl p<0.009) and lower albumin (3.7 vs. 3.8 g/dl p<0.038) with mean glomerular filtration rate estimated by CKD-EPI without significant difference with the PHC group (PHC 7.9 ± 3 .8, GHC 7.7 ± 3.8, p 0.613). The proportion of transplanted patients was higher in the PHC group, 40.6 vs 14.7% in the GHC group(p<0.0001), and this group had a higher survival rate (Log-Rank test p <0.021). In multivariate analysis, GHC was one of the predictors of mortality (OR 1.384, 95% CI 1.015-1.888, p 0.040), showing this factor's influence on dialysis patients' survival. Conclusions: Starting hemodialysis with GHC was associated with higher mortality. This patient's group had less access to kidney transplantation.