Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China

Overview

Journal Chin Med J (Engl)

Specialty General Medicine

Date 2017 Apr 12

PMID 28397716

Citations 14

Authors

Kang-Kang Song

De-Long Zhao

Yuan-Da Wang

Yong Wang

Xue-Feng Sun

Li-Ning Miao

Zhao-Hui Ni

Hong-Li Lin

Fu-You Liu

Ying Li

Ya-Ni He

Nian-Song Wang

Cai-Li Wang

Ai-Hua Zhang

Meng-Hua Chen

Xiao-Ping Yang

Yue-Yi Deng

Feng-Min Shao

Shu-Xia Fu

Jing-Ai Fang

Guang-Yan Cai

Xiang-Mei Chen

Affiliations

Soon will be listed here.

Abstract

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.

Citing Articles

Construction and validation of a nomogram to predict 1-year mortality risk in patients with HIV/AIDS undergoing maintenance hemodialysis.

Xian Z, Song X, Wang Y, Yang T, Mao N Ren Fail. 2025; 47(1):2461665.

PMID: 39962711 PMC: 11837922. DOI: 10.1080/0886022X.2025.2461665.

Modified creatinine index for predicting prognosis in hemodialysis patients: a systematic review and meta-analysis.

Ye T, Du J, Li P, Rong D, Gu W, Yao Y Ren Fail. 2024; 46(2):2367026.

PMID: 39120108 PMC: 11318488. DOI: 10.1080/0886022X.2024.2367026.

Strategies to Improve Long-Term Outcomes for Patients with Chronic Kidney Disease in China.

Liu J, Shi Y, Diao Y, Zeng X, Fu P Kidney Dis (Basel). 2023; 9(4):265-276.

PMID: 37899997 PMC: 10601912. DOI: 10.1159/000530022.

Infection status and clinical characteristics of COVID-19 in maintenance hemodialysis patients in Wuhan during the omicron pandemic.

Liu H, Jiang N, Min Y, Huang D, Liu H, Li H Medicine (Baltimore). 2023; 102(36):e35063.

PMID: 37682194 PMC: 10489297. DOI: 10.1097/MD.0000000000035063.

Cause of death and influencing factors of chronic renal failure on maintenance hemodialysis.

Fan X, Li J, Bi Z, Liang W, Wang F Pak J Med Sci. 2023; 39(5):1378-1382.

PMID: 37680805 PMC: 10480753. DOI: 10.12669/pjms.39.5.7037.

References

Kotanko P, Thijssen S, Usvyat L, Tashman A, Kruse A, Huber C . Temporal evolution of clinical parameters before death in dialysis patients: a new concept. Blood Purif. 2009; 27(1):38-47. DOI: 10.1159/000167007. View

Yang H, Curinga G, Giachelli C . Elevated extracellular calcium levels induce smooth muscle cell matrix mineralization in vitro. Kidney Int. 2004; 66(6):2293-9. DOI: 10.1111/j.1523-1755.2004.66015.x. View

Kardys I, Vliegenthart R, Oudkerk M, Hofman A, Witteman J . The female advantage in cardiovascular disease: do vascular beds contribute equally?. Am J Epidemiol. 2007; 166(4):403-12. DOI: 10.1093/aje/kwm115. View

Marfella R, Esposito K, Giunta R, Coppola G, De Angelis L, Farzati B . Circulating adhesion molecules in humans: role of hyperglycemia and hyperinsulinemia. Circulation. 2000; 101(19):2247-51. DOI: 10.1161/01.cir.101.19.2247. View

Shanahan C, Crouthamel M, Kapustin A, Giachelli C . Arterial calcification in chronic kidney disease: key roles for calcium and phosphate. Circ Res. 2011; 109(6):697-711. PMC: 3249146. DOI: 10.1161/CIRCRESAHA.110.234914. View

Port F, Pisoni R, Bommer J, Locatelli F, Jadoul M, Eknoyan G . Improving outcomes for dialysis patients in the international Dialysis Outcomes and Practice Patterns Study. Clin J Am Soc Nephrol. 2007; 1(2):246-55. DOI: 10.2215/CJN.01050905. View

Johansen K, Finkelstein F, Revicki D, Evans C, Wan S, Gitlin M . Systematic review of the impact of erythropoiesis-stimulating agents on fatigue in dialysis patients. Nephrol Dial Transplant. 2011; 27(6):2418-25. DOI: 10.1093/ndt/gfr697. View

. K/DOQI clinical practice guidelines for bone metabolism and disease in chronic kidney disease. Am J Kidney Dis. 2003; 42(4 Suppl 3):S1-201. View

de Mutsert R, Grootendorst D, Indemans F, Boeschoten E, Krediet R, Dekker F . Association between serum albumin and mortality in dialysis patients is partly explained by inflammation, and not by malnutrition. J Ren Nutr. 2009; 19(2):127-35. DOI: 10.1053/j.jrn.2008.08.003. View

10.

Wingard D, Suarez L, Barrett-Connor E . The sex differential in mortality from all causes and ischemic heart disease. Am J Epidemiol. 1983; 117(2):165-72. DOI: 10.1093/oxfordjournals.aje.a113527. View

11.

Murray C, Lopez A . Mortality by cause for eight regions of the world: Global Burden of Disease Study. Lancet. 1997; 349(9061):1269-76. DOI: 10.1016/S0140-6736(96)07493-4. View

12.

Anand I, Chandrashekhar Y, Ferrari R, Poole-Wilson P, Harris P . Pathogenesis of oedema in chronic severe anaemia: studies of body water and sodium, renal function, haemodynamic variables, and plasma hormones. Br Heart J. 1993; 70(4):357-62. PMC: 1025332. DOI: 10.1136/hrt.70.4.357. View

13.

Weng C, Hu C, Yen T, Hsu C, Huang W . Nutritional Predictors of Mortality in Long Term Hemodialysis Patients. Sci Rep. 2016; 6:35639. PMC: 5067672. DOI: 10.1038/srep35639. View

14.

Daratha K, Short R, Corbett C, Ring M, Alicic R, Choka R . Risks of subsequent hospitalization and death in patients with kidney disease. Clin J Am Soc Nephrol. 2012; 7(3):409-16. DOI: 10.2215/CJN.05070511. View

15.

Kotanko P, Kooman J, van der Sande F, Kappel F, Usvyat L . Accelerated or out of control: the final months on dialysis. J Ren Nutr. 2014; 24(6):357-63. DOI: 10.1053/j.jrn.2014.06.011. View

16.

Fox C, Coady S, Sorlie P, Levy D, Meigs J, DAgostino Sr R . Trends in cardiovascular complications of diabetes. JAMA. 2004; 292(20):2495-9. DOI: 10.1001/jama.292.20.2495. View

17.

Lukowsky L, Kheifets L, Arah O, Nissenson A, Kalantar-Zadeh K . Nutritional predictors of early mortality in incident hemodialysis patients. Int Urol Nephrol. 2013; 46(1):129-40. PMC: 3870190. DOI: 10.1007/s11255-013-0459-2. View

18.

Hecking M, Bieber B, Ethier J, Kautzky-Willer A, Sunder-Plassmann G, Saemann M . Sex-specific differences in hemodialysis prevalence and practices and the male-to-female mortality rate: the Dialysis Outcomes and Practice Patterns Study (DOPPS). PLoS Med. 2014; 11(10):e1001750. PMC: 4211675. DOI: 10.1371/journal.pmed.1001750. View

19.

Herselman M, Esau N, Kruger J, Labadarios D, Moosa M . Relationship between serum protein and mortality in adults on long-term hemodialysis: exhaustive review and meta-analysis. Nutrition. 2009; 26(1):10-32. DOI: 10.1016/j.nut.2009.07.009. View

20.

Chen X, Chen Z, Ma X, Ding B, Ling H, Shi Z . Aortic Artery and Cardiac Valve Calcification are Associated with Mortality in Chinese Hemodialysis Patients: A 3.5 Years Follow-up. Chin Med J (Engl). 2015; 128(20):2764-71. PMC: 4736882. DOI: 10.4103/0366-6999.167315. View