Development and Validation of Prediction Models for All-Cause Mortality and Cardiovascular Mortality in Patients on Hemodialysis: A Retrospective Cohort Study in China

Abstract

Purpose This study aimed to develop two predictive nomograms for the assessment of long-term survival status in hemodialysis (HD) patients by examining the prognostic factors for all-cause mortality and cardiovascular (CVD) event mortality. Patients and methods A total of 551 HD patients with an average age of over 60 were included in this study. The patients’ medical records were collected from our hospital and randomly allocated to two cohorts: the training cohort (n=385) and the validation cohort (n=166). We employed multivariate Cox assessments and fine-gray proportional hazards models to explore the predictive factors for both all-cause mortality and cardiovascular event mortality risk in HD patients. Two nomograms were established based on predictive factors to forecast patients’ likelihood of survival for 3, 5, and 8 years. The performance of both models was evaluated using the area under the curve (AUC), calibration plots, and decision curve analysis. Results The nomogram for all-cause mortality prediction included seven factors: age ≥ 60, sex (male), history of diabetes and coronary artery disease, diastolic blood pressure, total triglycerides (TG), and total cholesterol (TC). The nomogram for cardiovascular event mortality prediction included three factors: history of diabetes and coronary artery disease, and total cholesterol (TC). Both models demonstrated good discrimination, with AUC values of 0.716, 0.722 and 0.725 for all-cause mortality at 3, 5, and 8 years, respectively, and 0.702, 0.695, and 0.677 for cardiovascular event mortality, respectively. The calibration plots indicated a good agreement between the predictions and the decision curve analysis demonstrated a favorable clinical utility of the nomograms. Conclusion Our nomograms were well-calibrated and exhibited significant estimation efficiency, providing a valuable predictive tool to forecast prognosis in HD patients.

Association between illness perception and social alienation among maintenance hemodialysis patients: The mediating role of fear of progression

“…Second, as a result of long-term hemodialysis, MHD patients’ physical function, muscle strength, and functional motor ability have declined, their social function has gradually weakened, and they have become more dependent on their caregivers for support and assistance, which has brought double pressure on the patients’ body and psychology, and exacerbated social alienation. Lastly, MHD patients have high rates of cardiovascular events and mortality [ 15 , 71 ], and patients have negative perceptions of the disease [ 72 ], leading to fear of disease progression and increased social alienation.…”

“…MHD patients suffer from more complications than others, such as chronic pain [ 10 , 11 ], itchy skin [ 12 ], chronic fatigue [ 13 ] and muscle spasms [ 14 ], etc. Meanwhile, the incidence and mortality rates of cardiovascular diseases in MHD patients are higher than those in the general population [ 15 ], so the uncertainty of the disease prognosis, coupled with the pain caused by the treatment, can lead to feelings of worry and fear in patients. Chronic and excessive fear of disease progression affects patients’ social functioning [ 16 ], prompting MHD patients to choose to withdraw and distance themselves from daily interpersonal interactions, which in turn leads to helplessness and loneliness [ 17 ], that is, a state of “social alienation”.…”