Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China
Kang-Kang Song1, De-Long Zhao1, Yuan-Da Wang1, Yong Wang1, Xue-Feng Sun1, Li-Ning Miao2, Zhao-Hui Ni3, Hong-Li Lin4, Fu-You Liu5, Ying Li6, Ya-Ni He7, Nian-Song Wang8, Cai-Li Wang9, Ai-Hua Zhang10, Meng-Hua Chen11, Xiao-Ping Yang12, Yue-Yi Deng13, Feng-Min Shao14, Shu-Xia Fu15, Jing-Ai Fang16, Guang-Yan Cai1, Xiang-Mei Chen1
1 Department 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
2 Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China
3 Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center, Shanghai 200127, China
4 Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China
5 Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China
6 Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, Hebei 050081, China
7 Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China
8 Department of Nephrology, Shanghai Jiao Tong University, Affiliated The Sixth People's Hospital, Shanghai 200233, China
9 Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014040, China
10 Department of Nephrology, Peking University Third Hospital, Beijing 100191, China
11 Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China
12 Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832008, China
13 Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China
14 Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China
15 Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China
16 Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China
Prof. Xiang-Mei Chen
Department 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
Source of Support: None, Conflict of Interest: None
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.