Risk Factors Affecting Mortality in Asian Hemodialysis Patients: A 15-Year Study From Pakistan

Background End-stage renal disease (ESRD) impacts millions worldwide, with higher mortality rates despite progress in renal replacement therapy. Although numerous risk variables have been recognized, comprehensive long-term data from South Asia remain scarce. Various studies have been done to identify risk factors causing mortality in ESRD patients on hemodialysis (HB), including diabetes, cardiovascular disease, infections, age and dialysis prescription, and its compliance, and efforts to improve the outcome in this vulnerable population. However, the majority of these studies are shorter. We conducted this study for 15 years to see the effect of various risk factors on mortality and to identify modifiable risk factors to improve survival in this patient population. Materials and methods Retrospective cohort research was undertaken at the dialysis unit of a tertiary care hospital, analyzing risk variables and mortality in patients with ESRD undergoing maintenance HD from January 2006 to December 2021. Data were gathered utilizing a pre-structured questionnaire encompassing demographics, comorbidities, dialysis frequency, vascular access type, and survival outcomes. Statistical analysis utilized SPSS (IBM SPSS Statistics for Windows, IBM Corp., Version 25, Armonk, NY), employing chi-square tests for categorical variables and Cox regression for survival analysis, with p < 0.05 deemed significant. Results Nine hundred sixty-nine patients were enrolled, 326 were lost to follow, and 84 (13%) expired. The study comprised 54.8% (46) male and 45.2% (38) female, with an average survival period of 28.4 months. The results indicated that thrice-weekly HD had significantly improved survival compared to twice-weekly HD (p < 0.05). The utilization of CVC is associated with an elevated mortality risk (HR = 2.18, p < 0.05) in comparison to AV fistula. Male sex and diabetes were independent predictors of mortality (p < 0.05). The predominant causes of mortality were undetermined (34.5%), infections/sepsis (28.6%), and heart conditions (26.2%). Conclusion This 15-year study identifies modifiable risk factors influencing mortality in Pakistani patients with ESRD. Enhancing HD frequency and circumventing CVC utilization may markedly increase survival rates. The results highlight the necessity for timely AV fistula development and adequate dialysis frequency in resource-constrained environments.