Predictors of Early Mortality in Patients Initiating Maintenance Hemodialysis: Study from a Tertiary Care Hospital in Pakistan
Keywords:
arteriovenous fistula; early mortality; end-stage renal disease; hemodialysis; Pakistan; vascular accessAbstract
Background: End-stage renal disease (ESRD) requiring maintenance hemodialysis (HD) is rising across Pakistan and the first 90 days after dialysis initiation remain the period of highest mortality risk. Local evidence on the predictors of this early mortality beyond crude mortality rates and vascular access alone is still limited.
Objective: To identify the clinical, demographic and laboratory predictors of 90 days mortality among patients initiating maintenance hemodialysis at a tertiary care hospital in Pakistan.
Methods: This cross-sectional study enrolled 400 patients initiating maintenance hemodialysis for the first time. Baseline demographic, clinical and laboratory data were recorded at initiation and each patient was followed for 90 days for all-cause mortality. Predictors were assessed using univariable comparisons followed by multivariable binary logistic regression with adjusted odds ratios (AORs) and 95% confidence intervals (CIs) reported.
Results: Of the 400 patients (mean age 53.08 ± 14.44 years; 63.0% female; 65.8% rural), 185 (46.3%) died within 90 days of initiation. Vascular access type was the only variable independently associated with early mortality patients starting hemodialysis through a temporary catheter had markedly higher odds of death than those starting through an arteriovenous (AV) fistula (crude OR 6.17, 95% CI 3.99–9.55; adjusted OR 6.22, 95% CI 4.01–9.65, Wald χ2 = 66.73, p<0.001). Age, sex, diabetes, hypertension and baseline laboratory parameters (blood urea, creatinine, hemoglobin, calcium, phosphorus, cholesterol, triglycerides) did not differ significantly between survivors and non-survivors. Rural residence showed a borderline univariable association that did not persist after adjustment (AOR 1.41, 95% CI 0.89–2.23, p=0.142).
Conclusion: Vascular access type is the dominant and most readily modifiable predictor of early mortality after hemodialysis initiation in this study. The near six-fold excess risk associated with catheter based initiation underscores the urgent need for structured pre-dialysis planning, timely referral and expanded fistula creation services to reduce the exceptionally high burden of early death observed locally
