Risk Factors for Mortality Among Patients on Hemodialysis in India: A Case-Control Study

Mortality in hemodialysis (HD) exceeds that of many solid organ cancers, despite advancements in care. This study was conducted to understand mortality in a large dialysis network of Indian HD patients and attempt to elucidate risk factors for mortality. We performed a case-control study of deaths among patients undergoing HD across 203 centers in India from January 1 to March 31, 2021 with an age-matched control of survivors. We reviewed demographic, dialysis, clinical, and socioeconomic factors. Out of 17,659 patients on dialysis, 554 cases (non-survivors) and 623 age-matched controls (survivors) patients were followed up. The mean age was 54.9 ± 13.8 years, 70.5% (391) of them were males. Gender, BMI, dialysis frequency, HD vintage time, history of diabetes, and heart failure were similar between non-survivors and survivors. Lower education level, payment under public insurance, dialysis facility under a public-private partnership, vascular access via catheter, hemoglobin <8 g/dL levels, serum albumin <3.5 g/dL were significantly higher, hospitalizations in 3 months prior to death were more frequent among non-survivors. Factors including Hb <8 g/dL, temporary catheter, serum albumin less <3.5 g/dL, lower educational status, and dialysis under public insurance are associated with poorer survival in our population. Our findings have implications for designing interventions needed to improve outcomes for evolving policy and public-payer systems.