Mapping the mortality burden in hemodialysis patients. A multicenter observational study

Introduction: In patients with chronic kidney disease (CKD), cardiovascular disease is considered the leading cause of mortality. This study aims to analyze mortality and its associated factors in patients undergoing hemodialysis (HD) and hemodiafiltration (HDF) treatments at 14 private centers in Ecuador. Methods: This observational research was conducted from 2018 to 2022. Patients who received conventional three-weekly therapy were included. Those who died by the end of the observation period (Group 1-G1) were compared with those who were alive (Group 2-G2). The variables assessed included demographic data, comorbidities, clinical indicators, laboratory results, and impedance descriptions. Logistic regression was performed to obtain the odds ratio (OR). Results: A total of 821 patients in G1 and 3,586 in G2 were analyzed, yielding a mortality rate of 22.89% over 42 months (6.54% per year). There were 182 deaths attributed to cardiovascular causes (22.17%), 162 to infections (19.73%), and 477 from other causes (58.09%). Patients on HDF in G1 accounted for 167 cases (20.3%), while in G2, there were 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). 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 primary causes of death were non-cardiovascular, cardiovascular, and infections. Higher albumin concentration, elevated hemoglobin levels, increased lean tissue index, and longer effective weekly treatment duration were identified as protective factors against mortality.