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Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China
Kang-Kang Song1, De-Long Zhao1, Yuan-Da Wang1
1Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
Insights
Patients undergoing maintenance hemodialysis (MHD) face high mortality risks. This study identified male sex, older age, and diabetic nephropathy as key mortality risk factors in MHD patients.
Area of Science:
- Nephrology
- Internal Medicine
- Public Health
Background:
- Patients on maintenance hemodialysis (MHD) exhibit a high risk of mortality.
- Previous studies often utilized baseline data; this research analyzed recent patient data preceding adverse outcomes.
Purpose of the Study:
- To identify factors associated with all-cause mortality in maintenance hemodialysis patients.
- To analyze characteristics of patients immediately preceding death using the most current data available.
Main Methods:
- Retrospective data collection from 4104 patients across 16 Chinese blood purification centers (2012-2014).
- Participants were categorized into survival and death groups.
- Logistic regression analysis was employed to determine factors linked to mortality.
Main Results:
- Key mortality risk factors included male sex, advanced age, and diabetic nephropathy (DN).
- Protective factors identified were higher serum calcium, hemoglobin, albumin levels, and use of a noncuffed catheter for dialysis.
- Patients who died had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, and Kt/V compared to survivors.
Conclusions:
- Male sex, older age, diabetic nephropathy, and lower levels of hemoglobin, albumin, and serum calcium are significantly associated with increased mortality risk in hemodialysis patients.
- Maintaining adequate levels of hemoglobin, albumin, and serum calcium may be crucial for improving survival rates in this population.
Background:
Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.
Methods:
Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.
Results:
In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.
Conclusions:
Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.