Turkish Journal of Nephrology
Original Article

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

1.

Amgen Turkey, İstanbul, Turkey

2.

Division of Nephrology, Department of Internal Medicine, Demiroğlu Bilim University School of Medicine, İstanbul, Turkey

3.

Division of Nephrology, Department of Internal Medicine, Ankara University School of Medicine, Ankara, Turkey

4.

Division of Nephrology, Department of Internal Medicine, Hacettepe University School of Medicine, Ankara, Turkey

5.

School of Medicine, Atilim University, Ankara, Turkey

6.

Division of Dialysis, Biruni University Vocational School of Health Sciences, İstanbul, Turkey

7.

Division of Nephrology, Department of Internal Medicine, Gazi University School of Medicine, Ankara, Turkey

Turkish J Nephrol 2022; 31: 116-126
DOI: 10.5152/turkjnephrol.2022.21133
Read: 244 Downloads: 77 Published: 08 April 2022

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

Cite this article as: Kızılırmak P, Ecder T, Ateş K, et al. Main outcomes of the DIYAL-TR study: Regional differences of mortality and morbidity in chronic hemodialysis patients. Turk J Nephrol. 2022;31(2):116-126.

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