Abstract: 【Abstract】Objective To analyze the correlation between the hemodialysis initiation timing assessment using estimated glomerular filtration rate (eGFR) or dialysis initiation based on fuzzy mathematics equation (DIFE) and survival prognosis in patients undergoing maintenance hemodialysis (MHD). Methods A total of 252 MHD patients were divided into early dialysis group, suitable dialysis group and late dialysis group based on eGFR or DIFE assessment method. Their clinical indicators at the beginning of dialysis were compared among the groups, and the relationship between the clinical indicators and survival prognosis was analyzed. Results There were no significant differences in overall survival time among early dialysis group, suitable dialysis group and late dialysis group divided using either eGFR value or DIFE value (χ2=4.059 and 1.162 respectively, P=0.131 and 0.559 respectively). Age (HR=1.041, 95% CI 1.022～1.060, P<0.001), primary etiology of primary glomerulopathy (HR=0.378, 95% CI 0.219～0.653, P<0.001) or diabetic nephropathy (HR=2.092, 95% CI 1.250～3.498, P=0.005), and more than 3 comorbidities (HR=2.591, 95% CI 1.457～4.606, P=0.001) were the factors influencing survival prognosis of the patients. COX multivariate analysis showed that age was an independent risk factor for survival prognosis of the patients divided using either eGFR or DIFE (HR=1.035 and 1.043, respectively; 95% CI 1.013～1.057 and 1.020～1.067, respectively; P=0.001 and <0.001, respectively), and primary etiology of glomerular disease was a protective factor (HR=0.465 and 0.502, respectively; 95% CI 0.246～0.877 and 0.267～0.943, respectively; P=0.018 and 0.032, respectively). Conclusion Hemodialysis initiation time assessment using either eGFR or DIFE has no significant effect on the overall survival prognosis of the patients. It is reasonable to include several indexes into the assessment system of hemodialysis initiation timing after quantifying and assigning their different weights.

Key words: Hemodialysis, Timing of hemodialysis, Evaluation method, Survival and prognosis