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Abstract. Diabetic patients undergoing hemodialysis demonstrate much worse survival rates than do nondiabetic patients undergoing hemodialysis. To search for risk predictors, a prospective cohort study was performed with 245 hemodialysis patients, including 84 with diabetes mellitus, for 2 yr. C-reactive protein, troponin T (TnT), total, HDL, LDL, and lipoprotein(a) cholesterol, apoA2, apoB, triglyceride, fibrinogen, Ddimer, albumin, and creatinine levels and clinical characteristics at the time of entry were recorded. Survival rates were compared with Kaplan-Meier and Cox regression analyses. Forty-three diabetic patients and 30 nondiabetic patients died. Among diabetic patients, oliguria (Ͻ200 ml/d) (relative risk, 3.24; 95% confidence interval, 1.63 to 6.41; P ϭ 0.001), elevated C-reactive protein levels (relative risk, 2.57; 95% confidence interval, 1.06 to 6.18; P ϭ 0.035), and elevated D-dimer levels (relative risk, 2.36; 95% confidence interval, 1.11 to 5.01; P ϭ 0.025) predicted all-cause mortality rates. Oliguria was by far the most important predictor, particularly for infectious disease-related death (relative risk, 23.35; 95% confidence interval, 2.60 to 209.97; P ϭ 0.005). Among nondiabetic patients, elevated TnT levels (relative risk, 4.00; 95% confidence interval, 1.58 to 10.10; P ϭ 0.003), elevated D-dimer levels (relative risk, 3.45; 95% confidence interval, 1.27 to 9.33; P ϭ 0.015), and low cholesterol levels (relative risk, 3.61; 95% confidence interval, 1.34 to 9.71; P ϭ 0.011) predicted all-cause mortality rates. Subdivision of the causes of death among nondiabetic patients revealed that TnT levels predicted cardiovascular mortality rates (relative risk, 5.38; 95% confidence interval, 1.11 to 26.10; P ϭ 0.037) and infectious disease-related mortality rates (relative risk, 12.02; 95% confidence interval, 1.42 to 191.96; P ϭ 0.023). In conclusion, mortality predictors among patients undergoing hemodialysis differed substantially between diabetic and nondiabetic patients. Strategies to reduce mortality rates should consider these differences.Hemodialysis techniques have improved remarkably in recent decades, and prospective randomized trials have been conducted to improve outcomes among patients undergoing dialysis. A well accepted, albeit complex, set of guidelines has been established in the United States and Europe to ensure the quality of dialysis care. However, outcomes remain poor (1-3). Cardiovascular disease is the most common cause of death, and infectious causes are second in frequency (4,5). Dialysis-related strategies have not been successful in reducing mortality rates. The underlying renal disease, preexisting coronary artery disease, malnutrition, systemic inflammation [as indicated by C-reactive protein (CrP) levels], elevated levels of cardiac enzymes [notably troponin T (TnT)], and poor residual renal function (oliguria) have all been identified as risk factors (6 -12). Diabetes mellitus is the most important clinical risk factor; diabetic patients have a life expectancy with ...