Clinical features and hematological indices predicting all-cause mortality in patients undergoing hemodialysis; a retrospective cohort study

Abstract

Objective End-stage kidney disease carries high morbidity and mortality. This study aims to identify clinical, biochemical, and hematological factors linked to mortality in hemodialysis patients followed at our center over the past five years. Methods A single-center, retrospective cohort study was conducted on chronic hemodialysis patients. Hematological indices were calculated using data obtained from patient records. A p-value of <0.05 was considered statistically significant. Results The study included 80 patients, 21 of whom died, with a mean age of 60.7 +/- 16.4 years. Survivors and non-survivors did not differ significantly in age, blood pressure, body mass index or Kt/V (p>0.05). Arteriovenous fistula (AVF) was used in 62.5% of patients, with no mortality difference between AVF and catheter groups (p>0.05). Diabetes and hypertension were not linked to increased mortality (p>0.05), while coronary artery disease and congestive heart failure were associated with higher mortality (p<0.05). Serum creatinine, sodium, albumin and absolute lymphocyte counts were significantly lower in the deceased, while absolute neutrophil counts and CRP levels were higher (p<0.01). Multivariate logistic regression identified female gender, low serum albumin, and lymphopenia as independent risk factors for mortality (p<0.05). ROC analysis showed mortality increased by 6.9-fold with Systemic Immune-Inflammation Index (SII)>= 703, 10.4-fold with Neutrophil-Lymphocyte Ratio (NLR)>= 4.2, 34.2-fold with Prognostic Nutritional Index (PNI)<41.45, and 14.2-fold with lymphocyte count<1145 (p<0.05). Conclusion The present study identified female gender, low serum albumin, lymphopenia, and increased NLR and SII as independent mortality risk factors in hemodialysis patients. Particularly in patients with a PNI<41.45, there was a 34-fold increase in mortality.