title: Analysis of Factors Associated with Death in Maintenance Hemodialysis Patients: A Multicenter Study in China.
abstract: BACKGROUND
  Patients on hemodialysis have a high-mortality risk. This study analyzed factors associated with death in patients on maintenance hemodialysis (MHD). While some studies used baseline data of MHD patients, this study used the most recent data obtained from patients just prior to either a primary endpoint or the end of the study period to find the characteristics of patients preceding death.
  
  
  METHODS
  Participants were selected from 16 blood purification centers in China from January 2012 to December 2014. Patients' data were collected retrospectively. Based on survival status, the participants were divided into two groups: survival group and the death group. Logistic regression analysis was performed to determine factors associated with all-cause mortality.
  
  
  RESULTS
  In total, 4104 patients (57.58% male, median age 59 years) were included. Compared with the survival group, the death group had more men and more patients with diabetic nephropathy (DN) and hypertensive nephropathy. The patients preceding death also had lower levels of diastolic blood pressure, hemoglobin, serum albumin, serum calcium, serum phosphate, Kt/V, and higher age. Multivariate analysis revealed that male sex (odd ratio [OR]: 1.437, 95% confidence interval [CI]: 1.094-1.886), age (OR: 1.046, 95% CI: 1.036-1.057), and presence of DN (OR: 1.837, 95% CI: 1.322-2.552) were the risk factors associated with mortality. High serum calcium (OR: 0.585, 95% CI: 0.346-0.989), hemoglobin (OR: 0.974, 95% CI: 0.967-0.981), albumin (OR: 0.939, 95% CI: 0.915-0.963) levels, and dialysis with noncuffed catheter (OR: 0.165, 95% CI: 0.070-0.386) were protective factors based on a multivariate analysis.
  
  
  CONCLUSIONS
  Hemodialysis patients preceding death had lower hemoglobin, albumin, and serum calcium levels. Multivariate analysis showed that male sex, age, DN, low hemoglobin, low albumin, and low serum calcium were associated with death in hemodialysis patients.
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Kang-Kang
authors.initials: KK
authors.lastname: Song
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: De-Long
authors.initials: DL
authors.lastname: Zhao
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Yuan-Da
authors.initials: YD
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Yong
authors.initials: Y
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Xue-Feng
authors.initials: XF
authors.lastname: Sun
authors.affiliation: Department of Nephrology, The Second Hospital of Jilin University, Changchun, Jilin 130041, China.
authors.forename: Li-Ning
authors.initials: LN
authors.lastname: Miao
authors.affiliation: Department of Nephrology, Renji Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai Peritoneal Dialysis Research Center, Shanghai 200127, China.
authors.forename: Zhao-Hui
authors.initials: ZH
authors.lastname: Ni
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Dalian Medical University, Dalian, Liaoning 116011, China.
authors.forename: Hong-Li
authors.initials: HL
authors.lastname: Lin
authors.affiliation: Department of Nephrology, The Second Xiangya Hospital of Central South University, Changsha, Hunan 410011, China.
authors.forename: Fu-You
authors.initials: FY
authors.lastname: Liu
authors.affiliation: Department of Nephrology, Third Hospital of Hebei Medical University, Kidney Disease Research Center of Hebei Province, Shijiazhuang, Hebei 050081, China.
authors.forename: Ying
authors.initials: Y
authors.lastname: Li
authors.affiliation: Department of Nephrology, Institute of Surgery Research, Daping Hospital, Third Military Medical University, Chongqing 400042, China.
authors.forename: Ya-Ni
authors.initials: YN
authors.lastname: He
authors.affiliation: Department of Nephrology, Shanghai Jiao Tong University, Affiliated The Sixth People's Hospital, Shanghai 200233, China.
authors.forename: Nian-Song
authors.initials: NS
authors.lastname: Wang
authors.affiliation: Department of Nephrology, First Affiliated Hospital of Baotou Medical College, Baotou, Inner Mongolia 014040, China.
authors.forename: Cai-Li
authors.initials: CL
authors.lastname: Wang
authors.affiliation: Department of Nephrology, Peking University Third Hospital, Beijing 100191, China.
authors.forename: Ai-Hua
authors.initials: AH
authors.lastname: Zhang
authors.affiliation: Department of Nephrology, General Hospital of Ningxia Medical University, Yinchuan, Ningxia 750004, China.
authors.forename: Meng-Hua
authors.initials: MH
authors.lastname: Chen
authors.affiliation: Department of Nephrology, The First Affiliated Hospital of Shihezi University School of Medicine, Shihezi, Xinjiang 832008, China.
authors.forename: Xiao-Ping
authors.initials: XP
authors.lastname: Yang
authors.affiliation: Department of Nephrology, Longhua Hospital, Shanghai University of Traditional Chinese Medicine, Shanghai 200032, China.
authors.forename: Yue-Yi
authors.initials: YY
authors.lastname: Deng
authors.affiliation: Department of Nephrology, Henan Provincial People's Hospital, Zhengzhou, Henan 450003, China.
authors.forename: Feng-Min
authors.initials: FM
authors.lastname: Shao
authors.affiliation: Department of Nephrology, The Second Hospital of Hebei Medical University, Shijiazhuang, Hebei 050000, China.
authors.forename: Shu-Xia
authors.initials: SX
authors.lastname: Fu
authors.affiliation: Department of Nephrology, First Hospital of Shanxi Medical University, Taiyuan, Shanxi 030001, China.
authors.forename: Jing-Ai
authors.initials: JA
authors.lastname: Fang
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Guang-Yan
authors.initials: GY
authors.lastname: Cai
authors.affiliation: Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing 100853, China.
authors.forename: Xiang-Mei
authors.initials: XM
authors.lastname: Chen
mesh_terms: D000328:Adult; D000368:Aged; D002681:China; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D006435:Renal Dialysis / Q000009:adverse effects* / Q000401:mortality*; D012189:Retrospective Studies; D012307:Risk Factors