Long-term survival of incident hemodialysis patients who are hospitalized for congestive heart failure, pulmonary edema, or fluid overload

Background and objectives: Mortality in patients who are on maintenance hemodialysis and have congestive heart failure is high in small cohort studies. The aim of this study was to determine long-term survival in a large cohort of dialysis patients with congestive heart failure and suspected fluid overload or pulmonary edema. Design, setting, participants, & measurements: Data were analyzed, retrospectively, on 1,119,808 patients who started hemodialysis between January 1977 and December 1999. Survival was estimated from the first (index) hospital admission with congestive heart failure, fluid overload, or pulmonary edema, after 60 d of successful hemodialysis using the life-table method. The impact of patient characteristics on outcome was assessed by the Cox proportional hazards model. Results: Of the 310,456 patients included in the study, 233,454 were admitted with congestive heart failure, 63,886 with fluid overload, and 13,116 with pulmonary edema. The patients with congestive heart failure were older and often white and had diabetes or hypertension as the cause of renal failure. Deaths during the index hospital admission were 8.7% for congestive heart failure, 4.0% for fluid overload, and 6.6% for pulmonary edema. Five-year survival was 12.5, 20.2, and 21.3%, respectively. The independent positive predictors for mortality in these patients were age, male gender, diabetes, hypertension, history of cardiovascular disease, and congestive heart failure. Conclusions: This study demonstrates very poor survival in dialysis patients who present with congestive heart failure, pulmonary edema, or fluid overload compared with patients who present with congestive heart failure without renal failure. Meticulous management of cardiovascular risk should improve survival.