Mortality In Hemodialysis Patients Research Articles

The impact of body mass index on mortality according to age in hemodialysis patients: an analysis of the Korean Renal Data System.

The impact of age on the relationship between body mass index (BMI) and all-cause mortality in hemodialysis (HD) patients is not clearly understood. We analyzed the association between BMI and all-cause mortality, stratified by age, in patients undergoing HD using data from the Korean Renal Data System (KORDS). We analyzed 66,129 HD patients from the 2023 KORDS database, with data collected between 2001 and 2022. Patients were grouped by age: <65 years ("young" group, n = 24,589), 65-74 years ("younger-old" group, n = 17,732), and ≥75 years ("older-old" group, n = 23,808). Patients were further stratified into BMI quartiles. Kaplan-Meier curves and event time ratio for the relative change in the survival time were calculated. During the follow-up period, 14,360 (21.7%) of the patients died, with a median follow-up of 3.4 years. Kaplan-Meier curves revealed poorer outcomes in lower BMI quartiles across all age groups. The lowest BMI quartile was significantly associated with a shorter survival time compared to the highest BMI quartile, with a 15% reduction in the young group (p = 0.001) and a 12% reduction in the older-old group (p = 0.002). Predicted survival time increases with rising BMI in the young group, but the rate of increase slows in the younger-old group and plateaus in the older-old group after around a BMI of 25 kg/m2. The decline in survival time with age was more pronounced in the 7-year survival than the 2-year survival. Lower BMI is associated with higher all-cause mortality in HD patients, with a more pronounced impact in younger patients.

The role of lean body mass in predicting mortality in hemodialysis patients across different age groups

Lean body mass (LBM) serves as an indicator of muscle mass in body composition. Recently, studies have revealed increased mortality rates in dialysis patients with low LBM. However, studies analyzing the impact of age on LBM and mortality in dialysis patients remain limited. This study analyzed data from 26,625 adult hemodialysis patients registered in the Korean Society of Nephrology (KSN) registry from 2001 to 2020. We used the lean body mass index (LBMI), standardized by the square of height, to normalize lean body mass. Patients were first categorized by age group (20–49, 50–69, and ≥ 70 years). Subsequently, patients were categorized into quartile groups based on their LBMI (≤ 15.55, 15.55 < LBMI ≤ 16.52, 16.52 < LBMI ≤ 17.59, and > 17.59). This study revealed that the lowest LBMI group (≤ 15.55) was associated with decreased survival across all age groups, with this trend being particularly prominent in the older age groups. Within the 20–49 age group, factors such as diabetes exhibited a notable influence on mortality rates among hemodialysis patients. In the age group over 50, a low LBMI (≤ 15.55) had a greater impact on mortality rates in hemodialysis patients than diabetes. Understanding the importance of LBM in older patients undergoing dialysis is crucial for improving their prognosis.

Risk factors for the mortality of hemodialysis patients with COVID-19 in northern Hunan province, China

PurposeExploring the risk factors for mortality of hemodialysis patients undergoing COVID-19 and the changes in mortality before and after the opening of the epidemic in northern Hunan province, China.MethodsWe analyzed 230 hemodialysis patients with COVID-19 in the Yiyang Central Hospital from November 01, 2022 to February 28, 2023. Demographic data, laboratory data and public diseases were collected. Cox regression analysis was used to identify risk factors and independent predictors of mortality. The receiver operating characteristic (ROC) curve was used to determine the diagnostic value of risk factors in hemodialysis COVID-19 patients.ResultsThe average duration of the disease was 12.53 days. The mortality rate in our cohort was 28.70%. Independent predictors of mortality in our cohort were: age (hazard ratio [HR] 1.09; 95% confidence interval [CI], 1.05–1.14; P < 0.001), elevated procalcitonin (PCT) levels (HR 1.02; 95%CI, 1.01–1.03; P < 0.001), and higher white blood cell-neutrophil ratio (NWR) (HR 1.04; 95%CI, 1.04–1.07; P = 0.004). Areas under the ROC curve (AUC) for age, NWR, PCT, age*NWR were 0.70 (95%CI: 0.62–0.77), 0.82 (95%CI: 0.75–0.90), 0.64 (95%CI: 0.55–0.73), and 0.89 (0.85,0.94).ConclusionWe discovered that old age, high levels of NWR and PCT might be predictors of mortality, reported the causes and prognostic predictors of mortality in hemodialysis populations with COVID-19 from northern Hunan, China.

Sero-molecular prevalence of toxoplasmosis in hemodialysis and peritoneal dialysis patients in Markazi Province, Iran

BackgroundInfectious diseases, particularly parasitic infections such as toxoplasmosis, contribute significantly to the morbidity and mortality of hemodialysis patients. Toxoplasma gondii infection poses serious risks, especially to immunocompromised individuals. This study aimed to assess the prevalence of latent toxoplasmosis in dialysis patients in Markazi Province, Iran.MethodsA total of 181 patients (168 hemodialysis and 13 peritoneal dialysis) were included in this cross-sectional study. Blood samples were collected and tested for anti-Toxoplasma IgG and IgM antibodies using ELISA, while PCR was used to detect T. gondii DNA. Data were analyzed using SPSS, with P < 0.05 considered significant.ResultsOut of 181 patients, 123 (67.95%) were seropositive for IgG antibodies, with the highest prevalence in those aged over 60 years. No cases tested positive for IgM antibodies or T. gondii DNA. Age was significantly associated with higher seroprevalence (P < 0.05), but there were no significant differences regarding gender, dialysis type, or duration of dialysis.ConclusionThe high prevalence of latent toxoplasmosis in dialysis patients underscores the need for regular screening to prevent serious complications. Given the limitations of serological tests, molecular diagnostics like PCR should be considered for better detection in immunocompromised patients.

Continuous aspirin treatment improves cardiovascular events and all-cause mortality in hemodialysis patients with peripheral artery disease

Background Hemodialysis (HD) patients with peripheral arterial disease (PAD) are at heightened risk of adverse vascular events, and aspirin positively affects those outcomes. We aimed to investigate the association between different patterns of aspirin use and clinical vascular events in chronic HD patients with PAD. Methods This retrospective nationwide cohort study enrolled 758 chronic HD patients who had been diagnosed with PAD between January 1, 2008, and December 31, 2012, and followed up until the end of 2020. Patients were divided into three groups according to medication possession ratio (MPR) and continued use of aspirin (i.e., low MPR, high MPR but discontinuous prescription, and high MPR and continuous prescription). Percutaneous transluminal angioplasty (PTA), surgical bypass, lower leg amputation, cardiovascular events, cerebrovascular events, and all-cause mortality were evaluated. Results High MPR and continuous aspirin use had the lowest incidence of all-cause mortality and cardiovascular events compared with the two other groups, and it was significantly associated with low risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality (aHR: 0.58 [0.41–0.83], 0.49 [0.25–0.95], 0.57 [0.40–0.81], and 0.70 [0.55–0.88], respectively). Kaplan–Meier analysis revealed that event-free rates of PTA, cardiovascular events, and all-cause mortality of patients with high MPR and continuous aspirin treatment were the highest among the three groups (p < 0.05). Conclusion Among HD patients with PAD, high MPR and continuous aspirin use significantly reduced the risk of PTA, surgical bypass, cardiovascular events, and all-cause mortality and improved the event-free rates of PTA, cardiovascular events, and all-cause mortality during long-term follow-up.

Assessing the predictive power of nutritional indices on all-cause and cardiovascular mortality in hemodialysis patients: a longitudinal study

Background and Hypothesis The prognostic value of nutritional scoring tools in assessing the relationship between nutritional status and prognosis in hemodialysis patients is unclear. This multicenter retrospective cohort study compared the Prognostic Nutritional Index (PNI), Controlling Nutritional Status scores (CONUT), and Geriatric Nutritional Risk Index (GNRI) for predictive accuracy of all-cause and cardiovascular mortality, especially the impact of dynamic changes over time on prognosis. Methods Hemodialysis patients from four hospitals were included. Laboratory data and nutrition scores were collected at the initiation of dialysis, and at 6th, 12th, and 18th months after dialysis initiation. A joint model analyzed the relationship between dynamic nutritional scores and prognosis. Predictive values were assessed using the area under the curve (AUC). Results The study included 863 patients with a median follow-up of 37 months. During the follow-up, 23.8% of patients died, with 14% attributed to cardiovascular causes. Malnourished patients demonstrated higher risks for all-cause and cardiovascular mortality. Dynamic changes in PNI and GNRI scores were significantly associated with reduced all-cause and cardiovascular mortality risks. Precisely, longitudinal increases in PNI and GNRI scores corresponded to a 4% and 3% reduction in all-cause (PNI: HR, 0.96; 95% CI, 0.95–0.98; GNRI: HR, 0.97; 95% CI, 0.96–0.98) and cardiovascular mortality risk (PNI: HR, 0.96; 95% CI, 0.94–0.98; GNRI: HR, 0.97; 95% CI, 0.95–0.98) respectively, with longer dialysis duration. Changes in CONUT scores were not significantly associated with either all-cause or cardiovascular mortality. The AUCs of the three joint models indicated that the GNRI score (0.893) possessed higher predictive accuracy for all-cause mortality compared to PNI (0.832) and CONUT (0.852). Similar trends were observed for cardiovascular mortality. Conclusion Nutritional scores and their dynamic changes are intimately associated with mortality risk in hemodialysis patients. Compared to PNI and CONUT, the baseline GNRI and its post-dialysis variations demonstrate a superior predictive capability for all-cause and cardiovascular mortality in these patients.

Fluid overload trajectories and mortality in hemodialysis patients.

Fluid overload remains critical in managing patients with end-stage kidney disease. However, there is limited empirical understanding of fluid overload's impact on mortality. This study analyzes fluid overload trajectories and their association with mortality in hemodialysis patients. This longitudinal study included 9332 incident hemodialysis patients from the EuCliD database, treated in Fresenius Medical Care NephroCare dialysis centers across seven countries between January 2016 and December 2019, with follow-up until May 2023. Fluid overload was assessed using bioimpedance spectroscopy, and patients were grouped based on fluid overload trajectories using group-based trajectory modeling. Cox regression models, adjusted for potential confounders, were used to investigate the relationship between trajectory groups and mortality. Four distinct fluid overload trajectories were identified. Patients in the highest trajectory group (8.5% of the cohort) had more frequent background cardiovascular complications, lower BMI and serum albumin, and their adjusted mortality risk was 2.20 times higher than the lowest trajectory. There was a dose-response relationship between trajectories and mortality. The incidence rate of death increased with the degree of fluid overload, from 8.6 deaths per 100 person-years in the lowest trajectory to 18.6 in the highest. This longitudinal study highlights the significant risk of chronic fluid overload in hemodialysis patients. Latent trajectory analysis provides novel information into the dynamic nature of fluid overload and its impact on mortality in the hemodialysis population.

Predictors of survival and functioning of arteriovenous fistula in patients on hemodialysis during a one-year follow-up.

The mortality rate of hemodialysis patients is extremely high and it is significantly affected by vascular access dysfunction. Our research aimed to determine predictive parameters of arteriovenous fistula functioning and survival in a one-year follow-up period. The research was organized as a prospective, one-year study, which included 120 dialysis patients who were followed for one year. We recorded the demographic and gender structure, clinical parameters, and laboratory findings significant for the survival and functioning of arteriovenous fistulas. Laboratory findings are presented as the mean values of the analysis at the beginning and the end of the one-year control period. Univariable regression analysis confirmed the predictive significance of anastomosis positioning, type of vascular access, length of hemodialysis treatment, hemoglobin, Kt/V index values, and creatinine concentration for one-year survival, but multivariable regression analysis confirmed predictive significance only for length of treatment. Univariable regression analysis revealed significant predictors of vascular access function for the length of hemodialysis treatment, diastolic blood pressure, leukocytes, platelets, hemoglobin, creation of an arteriovenous fistula by a nephrologist, starting hemodialysis with a fistula and not with a central venous catheter, multivariable regression analysis confirmed predictive significance for the length of dialysis treatment and creation of an arteriovenous fistula by a nephrologist. A prognostically important parameter for the one-year survival of a patient on hemodialysis is the length of dialysis treatment. In contrast, predictive parameters for the functioning of an arteriovenous fistula are the length of dialysis and the creation of a fistula by a nephrologist.

Associations of vitamin D levels and clinical parameters with COVID-19 infection, severity and mortality in hemodialysis patients: A cohort study.

Vitamin D deficiency is prevalent among patients undergoing hemodialysis. This study aimed to investigate the associations between vitamin D levels and clinical parameters with the risk of COVID-19 infection, severity, and mortality in hemodialysis patients with end-stage kidney disease (ESKD). This retrospective cohort study included 198 hemodialysis patients from a single center. Vitamin D deficiency was defined by the last measurement of 25-hydroxycholecalciferol less than 20 ng/mL. Vitamin D deficiency and vitamin D supplements were combined to categorize patients into three groups: deficiency, uncertain deficiency, and likely sufficient. COVID-19 infection status, severity, and outcomes were recorded. Statistical analyses were performed to assess the associations between vitamin D levels and COVID-19 severity and mortality. Among the 198 patients, 73 patients (37%) were in the deficiency group, 29 patients (15%) had uncertain deficiency, and 96 patients (48%) were likely sufficient. The overall COVID-19 infection rate was 59%. The deficiency group had a similar infection rate (60.3%) compared to those with likely sufficient levels (54.2%). However, the severity and mortality rates of vitamin D deficiency group had a significantly higher rate than those with likely sufficient levels. Multivariate logistic regression analysis showed that vitamin D deficiency and uncertain deficiency group were significantly associated with an increased risk of COVID-19 severity (OR = 22.57, p = 0.01 and OR = 15.8, p = 0.03, respectively). Uncertain deficiency group was significantly associated with an increased risk of COVID-19 mortality (OR = 12.93, p = 0.04), while the deficiency group should similarly trend but did not reach statistical significance. Vitamin D deficiency is associated with an increased risk of COVID-19 severity in hemodialysis patients with ESKD. These findings suggest that monitoring and managing vitamin D levels may be important in reducing the risk of COVID-19 severity in this vulnerable population.

Impact of iron and erythropoiesis-stimulating agent dose on mortality of hemodialysis patients with cancer

Impact of iron and erythropoiesis-stimulating agent dose on mortality of hemodialysis patients with cancer

Global longitudinal strain correlates poorly with mortality in people with diabetes mellitus and receiving haemodialysis.

Haemodialysis (HD) is a life-sustaining treatment for individuals with end-stage kidney disease (ESKD). However, the risk of mortality remains significantly higher compared to the general population, even when matched for age and sex. Global longitudinal strain (GLS), derived from speckle tracking echocardiography, has shown promise as a predictor of mortality in HD patients. However, its prognostic utility in patients with multiple cardiovascular risk factors such as diabetes mellitus (DM) and receiving HD, remains unclear. This study aimed to evaluate the prognostic value of GLS in HD patients, with and without DM. This prospective study was a long term follow up extension study of an earlier published study that investigated a cohort of haemodialysis patients from a single centre with a comprehensive cardiovascular imaging protocol. All patients had an echocardiography with the use of speckle-tracking software to determine GLS. Patients were divided into Group A (with DM) and Group B (without DM). Patients were followed up until death, major adverse cardiovascular events (MACE), transplantation or the censoring date (29 February 2024). Statistical analyses were performed using univariate Cox proportional hazards models. A total of 184 patients receiving HD were included in the analysis. Patients with DM (Group A) had significantly higher all-cause mortality (ACM) (47.1% vs. 20.7%, P<0.001) and a lower chance of receiving a kidney transplant (13.2% vs. 43.1%, P<0.001). In Group A, GLS did not predict ACM, whereas in Group B, a GLS cutoff of -15.76% correlated with higher 5-year ACM (P=0.036). Left ventricular ejection fraction (LVEF) was a significant predictor of ACM in Group A (HR 0.98; P=0.036). GLS is a poor predictor of adverse outcomes in HD patients with DM, likely due to their high cardiovascular risk. In contrast, GLS was a significant predictor of mortality in non-diabetic HD patients. LVEF may be a more reliable prognostic indicator in high-risk diabetic patients.

Association between serum uric acid and all-cause and cardiovascular-related mortality in hemodialysis patients.

The association between serum uric acid (UA) and all-cause and cardiovascular-related mortality in hemodialysis (HD) patients is conflicting. We investigated this association and explored the effect modification of underlying nutritional status, as reflected in the lean tissue index (LTI) and the Geriatric Nutritional Risk Index (GNRI), which serve as markers of muscle mass and nutritional risk in HD patients. A retrospective cohort study was conducted from January 2019 to December 2023. We investigated the association between serum UA and the outcomes using the Cox proportional hazards regression and restricted cubic splines. Subgroup analyses based on the LTI and GNRI were conducted to explore possible effect modification. During a mean follow-up of 32.9 months, 876 patients who underwent HD were included in the analysis. The association between serum UA and all-cause mortality showed a non-linear U-shaped pattern (p = 0.007), with a survival benefit observed for the patients with serum UA levels between 3.4 and 6.8 mg/dL. In the multivariable-adjusted model, the low and high UA groups were associated with a greater risk of all-cause mortality compared to the reference UA group (hazard ratio (HR) =1.24, confidence interval (CI) 1.03-2.12, p = 0.027; HR = 1.09; CI 1.05-2.08. p = 0.012). In the low UA group, a greater risk of mortality was observed in patients with low LTI (<12.3; HR 1.56, 95% CI 1.22-1.82) and GNRI values (<102.1; HR 1.43, 95% CI 1.12-1.76), but not in those with high LTI and GNRI values. There was no significant association between serum UA and cardiovascular disease-related mortality. Our study showed that lower and higher serum UA levels increase the risk of all-cause mortality in HD patients. Among the patients with lower UA levels, low LTI and GNRI values showed a greater risk of mortality. This finding suggested that better nutritional status, rather than elevated UA levels, is likely to improve long-term survival in HD patients.

Benefits of Continuous Outpatient Orthopedic Consultations for Both Upper and Lower Body on the Mortality Rates of Hemodialysis Patients.

The purpose of the present observational study was to examine whether there is a difference in prognosis for hemodialysis patients with or without continued orthopedic outpatient visits over five years. Methods: One hundred and thirteen hemodialysis patients who visited the dialysis center of Takagi Hospital, Okawa, Japan, as of December 2017 were included in this study. Data were collected from the medical records until December 2022. All 113 patients were divided into two groups: patients who continuously visited the orthopedic outpatient department (n = 59) and those who did not (n = 54). Patients who had orthopedic consultation were divided into three semi-groups: patients who consulted for the upper body (n = 11), the lower body (n = 22), and both the upper and lower bodies (n = 26). During the five-year follow-up period, 13 out of 59 patients (22.0%) who had orthopedic consultation died, and this ratio tended to be lower compared to the mortality rate of patients without orthopedic consultation (37.0%) but not significant (P < 0.08). Duration of hemodialysis was significantly longer in patients with orthopedic consultation (P = 0.009). The mortality rate was significantly lower in patients who consulted for both upper and lower bodies than those without orthopedic consultation (P < 0.05, respectively). These differences were not observed in patients who consulted for only upper or lower bodies. The mortality of hemodialysis patients was significantly lower in the group which was undertaking continuous outpatient orthopedic consultations for both upper and lower bodies, which suggested that periodical consultation with orthopedics might be critical for hemodialysis patients.

Predicting early mortality in hemodialysis patients: a deep learning approach using a nationwide prospective cohort in South Korea

Early mortality after hemodialysis (HD) initiation significantly impacts the longevity of HD patients. This study aimed to quantify the effect sizes of risk factors on mortality using various machine learning approaches. A cohort of 3284 HD patients from the CRC-ESRD (2008–2014) was analyzed. Mortality risk models were validated using logistic regression, ridge regression, lasso regression, and decision trees, as well as ensemble methods like bagging and random forest. To better handle missing data and time-series variables, a recurrent neural network (RNN) with an autoencoder was also developed. Additionally, survival models predicting hazard ratios were employed using survival analysis techniques. The analysis included 1750 prevalent and 1534 incident HD patients (mean age 58.4 ± 13.6 years, 59.3% male). Over a median follow-up of 66.2 months, the overall mortality rate was 19.3%. Random forest models achieved an AUC of 0.8321 for first-year mortality prediction, which was further improved by the RNN with autoencoder (AUC 0.8357). The survival bagging model had the highest hazard ratio predictability (C-index 0.7756). A shorter dialysis duration (< 14.9 months) and high modified Charlson comorbidity index scores (7–9) were associated with hazard ratios up to 7.76 (C-index 0.7693). Comorbidities were more influential than age in predicting early mortality. Monitoring dialysis adequacy (KT/V), RAAS inhibitor use, and urine output is crucial for assessing early prognosis.

Effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic.

Hyperphosphatemia poses a significant risk for cardiovascular diseases and mortality in hemodialysis patients. Non-adherence to phosphate binders and a low-phosphate diet behavior contribute to this issue. Leveraging psychological and behavior change theories has proven effective in addressing many health risks. During the COVID-19 pandemic, face-to-face communication was limited, and telehealth served as a bridge to address healthcare gaps. This study aimed to determine the effect of a transtheoretical model-based intervention and motivational interviewing on hyperphosphatemia management via telehealth (TMT program) among hemodialysis patients during the COVID-19 pandemic. A two-arm parallel randomized controlled trial with assessors blinding involved 80 participants who were stratified block-randomized into either the TMT program group (n = 40) or the control group (Usual care; n = 40). Linear regression was used to compare the two groups on serum phosphorus levels, knowledge of hyperphosphatemia management, and dietary consumption behavior at the 24-week endpoint. The readiness to change (stage of change), self-efficacy, and phosphate binder adherence were assessed using Fisher's test. The TMT program demonstrated a significant reduction in serum phosphorus levels compared to usual care (mean difference = -1.03, 95% CI = -1.77, -0.29). Additionally, improvement in dietary consumption behavior related to phosphorus-containing foods was also observed (mean difference = 13.48, 95% CI = 8.41, 18.57). Positive effects emerged in the readiness to change (p < 0.001), self-efficacy in the appropriate use of phosphate binders (p = 0.025), and adherence to phosphate binders (p = 0.001) at the 24-week endpoint. However, groups did not differ in knowledge of hyperphosphatemia management (mean difference = 7.02, 95% CI = -1.03, 15.07). The study demonstrated that the TMT program has positive effects on reducing serum phosphorus levels, providing a hyperphosphatemia management strategy for ESRD patients undergoing hemodialysis via telehealth. TCTR20230628003, https://www.thaiclinicaltrials.org.

Pre-infection liver function is associated with all-cause mortality among hemodialysis patients with SARS-CoV-2 Omicron variant infection

Background There is ample evidence to suggest that patients infected with SARS-CoV-2 Omicron variant may experience liver dysfunction. However, the impact of pre-infection liver function on postinfection mortality rates remains inadequately researched. Methods Data from 847 hemodialysis (HD) patients, diagnosed with Omicron across six HD centers between December 2022 and February 2023, were analyzed. Initial liver function assessments were conducted, following which patients were monitored for mortality outcomes. The stepwise multivariable Cox regression analysis and receiver operating characteristic (ROC) curves were utilized to identify the predictors of mortality. Results From the total, 98 patients (11.6%) succumbed, with a majority (80/98) within a month postinfection. The deceased patients were observed to be mostly older males with an increased prevalence of diabetes and tumors, signifying higher AST and C-reactive protein levels. These patients also exhibited lower hemoglobin, albumin, and prealbumin levels. An elevated AST [per 1 IU increment; HR 1.04 (95% CI 1–1.04), p = 0.026], AST/ALT ratio [per 1 increment; HR 1.52 (95% CI 1.27–2.36), p = 0.004], and reduced prealbumin [per 10 mg/L increment; HR 0.93 (95% CI 0.9–0.96), p < 0.001] were discovered to be independent indicators of an increased mortality risk. Notably, AST, AST/ALT ratio, and prealbumin proved significant predictors of mortality (AUC values were 0.59, 0.65, and 0.79 respectively). Conclusions This study underscores that pre-infection liver function, specifically AST, AST/ALT ratio, and prealbumin levels, substantially influence the mortality rates in HD patients following Omicron infection. Therefore, careful consideration of these liver function parameters could guide superior patient management strategies and potentially decrease mortality rates within this at-risk population.

Osteopontin and Clinical Outcomes in Hemodialysis Patients.

Chronic kidney disease (CKD) and end-stage kidney disease (ESKD) are significant public health issues, with cardiovascular morbidity and mortality being the leading causes of death in hemodialysis patients. Osteopontin (OPN), a multifunctional glycoprotein, has emerged as a potential biomarker for vascular disease in CKD due to its role in inflammation, tissue remodeling, and calcification. This cohort study included 1124 hemodialysis patients from the PROGREDIRE study, a registry involving 35 dialysis units in Southern Italy. Serum osteopontin levels were measured using enzyme-linked immunosorbent assay (ELISA). The primary endpoints were all-cause and cardiovascular mortality. Multivariate Cox regression analyses were performed to assess the association between osteopontin levels and mortality, adjusting for traditional risk factors, biomarkers of inflammation, nutritional status, and ESKD-related factors. During a mean follow-up of 2.8 years, 478 patients died, 271 from cardiovascular causes. Independent correlates of osteopontin included alkaline phosphatase and parathyroid hormone. Elevated osteopontin levels were significantly associated with increased all-cause mortality (HR 1.19, 95% CI 1.09-1.31, p < 0.001) and cardiovascular mortality (HR 1.22, 95% CI 1.08-1.38, p = 0.001) after adjusting for confounders. Elevated osteopontin levels are associated with increased all-cause and cardiovascular mortality in hemodialysis patients. These findings implicate osteopontin in the high risk for death and cardiovascular disease in the hemodialysis population. Intervention studies are needed to definitively test this hypothesis.

Differences in association between hypoalbuminaemia and mortality among younger versus older patients on haemodialysis.

Ageing often affects biomarker production. Yet, clinical/optimal thresholds to guide clinical decisions do not consider this. Serum albumin decreases with age, but hypoalbuminaemia is defined as serum albumin <4.0g/dl. This study explores whether age might affect serum albumin levels and its association with mortality in haemodialysis patients. COSMOS (Current Management of Secondary Hyperparathyroidism: a Multicentre Observational Study) is a prospective, open-cohort, observational study of haemodialysis patients followed for 3 years. Binary logistic and linear regression were used to analyse the association between age and hypoalbuminaemia or serum albumin (continuous). Cox proportional hazard multivariate regression was used to examine the relationship between hypoalbuminaemia and mortality in patients younger and older than 65 years. Time-dependent receiver operating characteristic (ROC) curves were used to assess the discriminatory ability of serum albumin and optimal thresholds for predicting mortality. The present analysis included 5585 patients. The odds of experiencing hypoalbuminaemia increased with age [adjusted odds ratios=1.56(95%CI: 1.31-1.86), 1.89(95%CI: 1.59-2.24), 2.68(95%CI: 2.22-3.23) for 56-65, 66-75, and >75 years, respectively (reference ≤55 years; P value for trend: <0.001)]. Survival analysis showed that the association between hypoalbuminaemia and mortality was weaker in patients aged ≥65 compared to <65 years [hazard ratios: 1.36(95%CI: 1.17-1.57) and 1.81(95%CI:1.42-2.31) respectively; P value for interaction 0.004]. The ability of albumin levels to predict mortality was consistently higher in younger patients. Optimal albumin thresholds for predicting mortality were 3.7g/dl in patients younger than 65 years and 3.5g/dl in patients 65 years and older. Ageing is accompanied by lower albumin levels, and the association between hypoalbuminaemia and mortality may be modified by age. Different clinical thresholds that consider age may better discriminate risks associated with hypoalbuminaemia.

Association of hypoalbuminemia with hospitalization and mortality in hemodialysis patients with COVID-19.

Hypoalbuminemia is associated with poor nutritional status and inflammatory response in infectious diseases. It is commonly observed in COVID-19 patients. The aim of this study is to assess the association of serum albumin with hospitalization and mortality in dialysis patients with COVID-19. We retrospectively collected 250 dialysis patients, with and without COVID-19. Demographic characteristics, clinical symptoms, and laboratory tests on admission or the confirmation of COVID-19 were collected. Univariate logistic regression model was used to evaluate the association of various factors with hospitalization and death in these patients. A total of 250 patients were included between December 1, 2022, and February 1, 2023, in our dialysis center. Among them, 218 were dialysis patients with COVID-19, and 32 were without COVID-19. Ten patients died due to COVID-19, and 8 patients had clinical data. In dialysis patients with COVID-19, a significant difference in serum albumin levels was observed between outpatients (37.28 ± 4.01 g/L) and hospitalized patients (33.42 ± 3.82 g/L), as well as between survivors (37.12 ± 4.07 g/L) and non-survivors (31.92 ± 2.52 g/L). Univariate logistic regression showed that the reduced albumin levels were associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Our study revealed that reduced serum albumin is associated with an increased risk of hospitalization and mortality in dialysis patients with COVID-19. Low serum albumin levels suggest a poor prognosis and nutritional support may improve clinical outcomes.

Platelet count has a U-shaped association with mortality in hemodialysis patients

Our previous manuscript showed that thrombocytopenia predicts all-cause mortality in Chinese hemodialysis (HD) patients. Based on the role of platelets in coagulation, clot formation, and systemic inflammation, we speculate that high platelets increase risk of thrombo-embolic events, hence the mortality. However, research evidence is currently lacking. Therefore, we utilized data from a very large international cohort study to explore the association of platelet counts with mortality and cardiovascular (CV) death in hemodialysis (HD) patients. International data from 396 facilities enrolled in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phase 5 (2012–2015) were analyzed. Participants were divided into 3 groups according to their platelet counts (low: <100, normal: 100–300, high: >300*109). Associations between platelet counts and all-cause and CV mortality were analyzed using Cox regression, adjusted for confounders. There were 13,631 patients with median age of 65 years old. Males accounted for 61.2%. Mean platelet count was 205*109/L overall and ranged from 173 *109/L in China to 227 *109/L in Sweden. Overall, 2,348 (17.2%) patients died and 1017 (7.5%) died from CV disease. Both low (HR:1.48, 95% CI 1.21–1.80, p < 0.001) and high (HR:1.17, 95% CI 1.00- 1.35, p = 0.044) platelet counts were associated with higher all-cause mortality after adjustment for covariates; results for CV death were consistent. Platelet count has a U-shaped association with all-cause and CV mortality in HD patients, and thus may be used as an outcome predictor that is readily available among HD patients.