Main Outcomes of the DIYAL-TR Study: Regional\rDifferences of Mortality and Morbidity in Chronic\rHemodialysis Patients

Abstract

Objective: Variations in care at national or global level may have an impact on the prognosis of patients on chronic hemodialysis.\rWe aimed to describe regional differences in all-cause mortality or cardiovascular morbidity in chronic hemodialysis\rpatients in Turkey.\rMethods: We enrolled 2461 patients who were initiated chronic hemodialysis in 93 centers in Turkey between January 27,\r2017, and February 09, 2018. We included 2-year follow-up data of 1877 patients in this prospective study. The primary\routcome, the rate of composite endpoint of all-cause mortality or cardiovascular morbidity, was compared between geographical\rregions. Secondary outcomes were the rates of hospitalization and infections.\rResults: In total, 552 patients (29.4%) developed the primary outcome. The highest and lowest rates of primary outcome\roccurred in the Mediterranean (34.5%) and Southeastern (26.5%) & Central Anatolian regions (26.5%), respectively, with no\rsignificant differences across regions (P = .82). Hospitalization events were detected in 377 patients (20.1%). The highest\rrate of hospitalization was detected in the Black Sea region (33.8%), and the lowest (7.6%) in the Southeastern region. The\rregions did not differ in hospitalization rates (P = .88). Infections occurred in 11.3% (n = 212) of the patients. The highest and\rlowest rates of infections occurred in the Aegean (18.2%) and the Southeastern (2.9%) regions, respectively. We detected\rsignificant difference between geographic regions (P = .02).\rConclusions: Our study showed that almost 3 in every 10 chronic hemodialysis patients reached the primary endpoint\rof all-cause mortality/cardiovascular morbidity during the 2 years of follow-up. The occurrence of this outcome does not\rseem to exhibit geographical variation across the country.