Abstract: FR-PO0394
Eight-Factor Risk Score Predicts 30-Day Mortality in Patients on Maintenance Hemodialysis
Session Information
- Dialysis: Measuring and Managing Symptoms and Syndromes
November 07, 2025 | Location: Exhibit Hall, Convention Center
Abstract Time: 10:00 AM - 12:00 PM
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Ahmed, Areeg, NYC Health + Hospitals/Harlem, New York, New York, United States
- Alwali, Abdalmahmoud, NYC Health + Hospitals/Harlem, New York, New York, United States
- Konigbagbe, Oluwole Oluyinka Oluyemi, NYC Health + Hospitals/Harlem, New York, New York, United States
- Hassan, Muhammad Zaigham, NYC Health + Hospitals/Harlem, New York, New York, United States
- Phillips, Jerel A, NYC Health + Hospitals/Harlem, New York, New York, United States
- Thearle, Marie, NYC Health + Hospitals/Harlem, New York, New York, United States
- Dowie, Donna, NYC Health + Hospitals/Harlem, New York, New York, United States
- Anderson, Herman L., Harlem Hospital Center, New York, New York, United States
- Andrabi, Suhaib A., NYC Health + Hospitals/Harlem, New York, New York, United States
- Herbert, Leroy, NYC Health + Hospitals/Harlem, New York, New York, United States
Background
Patients on hemodialysis (HD) due to end-stage renal disease experience high risks for morbidity and mortality. Our objective was to develop a summary risk score from eight measures, representing such factors as dialysis adequacy, nutritional markers, and inflammation, to predict mortality in patients on HD.
Methods
We retrospectively analyzed data extracted from electronic health records between January 2017 and July 2024 from the 239 patients (53% male, 76% Black, 16% Hispanic) in the Harlem Hospital hemodialysis registry, representing 7,342 patient-months of HD. We developed a summary risk score, assigning one point for each of the following: spKtV <1.2, creatinine index (CI) <15 mg/kg/day, body fat <15%, albumin <3.5 g/dL, CRP >5 mg/L, phosphate <2.5 mg/dL, nPNA <1 g/kg/day, and prealbumin >35 mg/dL. Higher scores indicated greater risk. Chi-squared and t-tests assessed the association of risk scores with death within 30 days, followed by multivariable proportional hazards models adjusting for age, sex, race, and HD access type.
Results
Of the patient-months, 6.4% had spKtV<1.2, 4.9% had CI<15, 2.0% had body fat <15%, 9.9% had hypoalbuminemia, 30.3% had elevated CRP, 6.4% had hypophosphatemia, 56.2% had low nPNA, and 27.8% had prealbumin >35 mg/dL. During the study, 70 patients died. Decedents had higher risk scores in the month before death (1.96±1.22 vs. 1.42±0.94, p < 0.0001). A risk score of 3+ was associated with a 3.5-fold rise in mortality risk (OR 3.34 [95% CI 1.99, 5.60]; p< 0.0001). In multivariable analysis, each point increase raised mortality risk by 69% (HRR = 1.69 [95% CI 1.35, 2.10]; p < 0.0001). Similarly, in multivariable analysis, patients with scores of 3+ had lower survival (aHRR: 3.53 [95% CI 2.10, 5.94]; p < 0.0001).
Conclusion
A summary risk score derived from abnormalities in routinely measured monthly lab tests predicts mortality in patients on HD. Higher scores predict lower survival probability with markers that reflect the patient’s underlying malnutrition, inflammation, and reduced dialysis adequacy. Through sequential monitoring using this score, we can identify patients who may benefit from targeted interventions addressing the individual components and potentially improving survival.