Main Outcomes of the DIYAL-TR Study: Regional Differences of Mortality and Morbidity in Chronic Hemodialysis Patients

Abstract

Objective: Variations in care at national or global level may have an impact on the prognosis of patients on chronic hemodialysis. We aimed to describe regional differences in all-cause mortality or cardiovascular morbidity in chronic hemodialysis patients in Turkey. Methods: We enrolled 2461 patients who were initiated chronic hemodialysis in 93 centers in Turkey between January 27, 2017, and February 09, 2018. We included 2-year follow-up data of 1877 patients in this prospective study. The primary outcome, the rate of composite endpoint of all-cause mortality or cardiovascular morbidity, was compared between geographical regions. Secondary outcomes were the rates of hospitalization and infections. Results: In total, 552 patients (29.4%) developed the primary outcome. The highest and lowest rates of primary outcome occurred in the Mediterranean (34.5%) and Southeastern (26.5%) & Central Anatolian regions (26.5%), respectively, with no significant differences across regions (P =.82). Hospitalization events were detected in 377 patients (20.1%). The highest rate of hospitalization was detected in the Black Sea region (33.8%), and the lowest (7.6%) in the Southeastern region. The regions did not differ in hospitalization rates (P =.88). Infections occurred in 11.3% (n = 212) of the patients. The highest and lowest rates of infections occurred in the Aegean (18.2%) and the Southeastern (2.9%) regions, respectively. We detected significant difference between geographic regions (P =.02). Conclusions: Our study showed that almost 3 in every 10 chronic hemodialysis patients reached the primary endpoint of all-cause mortality/cardiovascular morbidity during the 2 years of follow-up. The occurrence of this outcome does not seem to exhibit geographical variation across the country.