Risk factors for in-hospital mortality in patients starting hemodialysis.
BACKGROUND
Incident hemodialysis patients have the highest mortality in the first several months after starting dialysis. This study evaluated the in-hospital mortality rate after hemodialysis initiation, as well as related risk factors.


METHODS
We examined in-hospital mortality and related factors in 2,692 patients starting incident hemodialysis. The study population included patients with acute kidney injury, acute exacerbation of chronic kidney disease, and chronic kidney disease. To determine the parameters associated with in-hospital mortality, patients who died in hospital (nonsurvivors) were compared with those who survived (survivors). Risk factors for in-hospital mortality were determined using logistic regression analysis.


RESULTS
Among all patients, 451 (16.8%) died during hospitalization. The highest risk factor for in-hospital mortality was cardiopulmonary resuscitation, followed by pneumonia, arrhythmia, hematologic malignancy, and acute kidney injury after bleeding. Albumin was not a risk factor for in-hospital mortality, whereas C-reactive protein was a risk factor. The use of vancomycin, inotropes, and a ventilator was associated with mortality, whereas elective hemodialysis with chronic kidney disease and statin use were associated with survival. The use of continuous renal replacement therapy was not associated with in-hospital mortality.


CONCLUSIONS
Incident hemodialysis patients had high in-hospital mortality. Cardiopulmonary resuscitation, infections such as pneumonia, and the use of inotropes and a ventilator was strong risk factors for in-hospital mortality. However, elective hemodialysis for chronic kidney disease was associated with survival.
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Eun Hui
EH
Bae
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Ha Yeon
HY
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Yong Un
YU
Kang
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Chang Seong
CS
Kim
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Seong Kwon
SK
Ma
Department of Internal Medicine, Chonnam National University Medical School, Gwangju, Korea.
Soo Wan
SW
Kim
Acute kidney injury; Cardiopulmonary resuscitation; Chronic kidney disease; Hemodialysis; In-hospital mortality