title: Survival of Patients on Hemodialysis and Predictors of Mortality: a Single-Centre Analysis of Time-Dependent Factors.
abstract: BACKGROUND
  This study aimed to evaluate the outcome and predictors of survival in hemodialysis patients of Hasheminejad Kidney Center where a comprehensive dialysis care program has been placed since 2004.
  
  
  METHODS
  Data of 560 hemodialysis patients were used to evaluate 9-year survival rates and predictors of mortality. Cox regression models included comorbidities as well as averaged and 6-month-averaged time-dependent values of laboratory findings as independent factors.
  
  
  RESULTS
  Survival rates were 91.9%, 66.0%, 46.3%, and 28.5%,  at 1, 3, 5, and 9 years, respectively, in all patients and 90.8%, 61.6%, 42.1%, and 28.0% in 395 incident patients starting hemodialysis after 2004. Adjusted survival models demonstrated age, male sex, diabetes mellitus, cardiovascular disease, and high-risk vascular access as baseline predictors of mortality, as well as averaged low hemoglobin level (hazard ratio [HR], 1.98; 95% confidence interval [CI], 1.36 to 2.90) and a single-pool KT/V < 1.2 (HR, 2.28; 95% CI, 1.60 to 3.26). The averaged high-density lipoprotein cholesterol (HR, 0.67; 95% CI, 0.55 to 0.81) and serum creatinine (HR, 0.71; 95% CI, 0.64 to 0.79) levels demonstrated protective effects. The adjusted time-dependent model further revealed the significant association of hypocalcemia (HR, 1.63; 95% CI, 1.13 to 2.34), hypercalcemia (HR, 1.50; 95% CI, 1.02 to 2.21), and hyperphosphatemia (HR, 1.68; 95% CI, 1.20 to 2.37) with death.
  
  
  CONCLUSIONS
  Our patients have relatively comparable survival rates with high-profile dialysis centers. Aiming to better achieve the recommended targets, especially hemoglobin and nutritional and bone metabolism factors, should be considered for optimal dialysis outcomes.
authors.forename: Shahrzad
authors.initials: S
authors.lastname: Ossareh
authors.affiliation: Hasheminejad Kidney Center, Iran University of Medical Sciences, Tehran, Iran. farhat.farrokhi@mail.utoronto.ca.
authors.forename: Farhat
authors.initials: F
authors.lastname: Farrokhi
authors.forename: Marjan
authors.initials: M
authors.lastname: Zebarjadi
mesh_terms: D000293:Adolescent; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D002318:Cardiovascular Diseases / Q000453:epidemiology / Q000401:mortality*; D002423:Cause of Death; D002561:Cerebrovascular Disorders / Q000401:mortality; D002648:Child; D008076:Cholesterol, HDL / Q000097:blood; D003404:Creatinine / Q000097:blood; D003920:Diabetes Mellitus / Q000453:epidemiology; D005260:Female; D006801:Humans; D006934:Hypercalcemia / Q000453:epidemiology; D054559:Hyperphosphatemia / Q000453:epidemiology; D006996:Hypocalcemia / Q000453:epidemiology; D007239:Infections / Q000401:mortality*; D007492:Iran / Q000453:epidemiology; D007676:Kidney Failure, Chronic / Q000097:blood / Q000453:epidemiology / Q000628:therapy*; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009369:Neoplasms / Q000401:mortality*; D016016:Proportional Hazards Models; D006435:Renal Dialysis; D012189:Retrospective Studies; D012307:Risk Factors; D012737:Sex Factors; D015996:Survival Rate; D013997:Time Factors; D014212:Tretinoin / Q000031:analogs & derivatives / Q000378:metabolism; D055815:Young Adult
chemical_list: D008076:Cholesterol, HDL; C077923:4-(2-hydroxyethoxy)retinoic acid; D014212:Tretinoin; D003404:Creatinine