Multicenter observational analysis of mortality in patients in hemodialysis programs

Abstract

Introduction: In patients with chronic kidney disease (CKD), cardiovascular disease is considered the leading cause of mortality. This study analyzes mortality and its associated factors among patients undergoing hemodialysis (HD) and hemodiafiltration (HDF) at 14 private centers in Ecuador.

Methods: This observational study was conducted between 2018 and 2022. Patients who received conventional therapy 3 days per week were included. Patients who died at the end of the observation period (Group 1-G1) were compared with those who were alive (Group 2-G2). The variables evaluated included demographic data, comorbidities, clinical indicators, laboratory results, and impedance descriptions. Logistic regression was performed to estimate the odds ratio (OR).

Results: A total of 821 patients were analyzed in G1 and 3,586 in G2, with a mortality rate of 22.89% in 42 months (6.54% per year). There were 182 deaths due to cardiovascular causes (22.17%), 162 due to infections (19.73%), and 477 due to other causes (58.09%). Patients with HDF in G1 accounted for 167 cases (20.3%), while in G2, 1,078 cases (30.5%) (p < 0.0001). Risk factors for mortality included the development of cerebrovascular disease (OR: 1.81), vascular disease with hypertension (OR: > 1.49), and type 2 diabetes mellitus (OR: > 1.33). The protective factors identified were albumin concentration (OR: 0.61), hemoglobin level (OR: 0.83), and lean tissue index (OR: 0.95).

Conclusion: The present study demonstrates that the leading causes of death were non-cardiovascular, cardiovascular, and infectious. Higher albumin concentration, elevated haemoglobin levels, higher lean tissue index, and longer duration of effective weekly treatment were identified as protective factors against mortality.