Abstract: PUB107
Hemoglobin-to-Creatinine Ratio as a Predictive Marker for Mortality Risk in First-Time Hemodialysis Patients: Evidence from a Lower-Middle-Income Country
Session Information
Category: Dialysis
- 801 Dialysis: Hemodialysis and Frequent Dialysis
Authors
- Moreno, Rodolfo Alejandro, Centro Medico Militar, Guatemala City, Guatemala
- Coello Rivera, Solange Elizabeth, Centro Medico Militar, Guatemala City, Guatemala
- Armas, David Alejandro, Centro Medico Militar, Guatemala City, Guatemala
- Ortiz, Dean Wesley, Senacyt, Guatemala City, Guatemala
- Garcia, Pablo, The University of New Mexico School of Medicine, Albuquerque, New Mexico, United States
Background
Access to predictive tools is essential in low-to-middle income settings where efficient resource allocation is critical to prevent mortality. Serum creatinine (Cr) and hemoglobin (Hb) are inexpensive and widely available tests that could potentially serve as predictive markers for in-hospital mortality in patients with acute kidney injury and chronic kidney disease
Methods
This is a retrospective cohort study from a registry of epidemiological and mortality data in first-time hemodialysis patients admitted to a teaching hospital in Guatemala from March 2021 and August 2024. Variables were assessed for normality using the K-S test and presented as medians with interquartile ranges or frequencies and percentages. The Hb/Cr ratio and its association with in-hospital mortality were evaluated using logistic regression
Results
Of 124 patients included the median age was 70 years; 33.9% were female.Type 2 diabetes and hypertension were present in 54.8 and 69.4% of patients respectively. The most common indications for hemodialysis were uremia (65.3%), fluid overload (12%) and metabolic acidosis (5.3%). Median Cr was 5.5 mg/dL, eGFR 10.6 mL/min/1.73m2 and Hb 9.9 g/dL. Median hospital length of stay was 20 days with cumulative in-hospital mortality of 25.8%. Logistic regression showed that Hb/Cr ratio was associated with in-hospital mortality (OR 1.38; 95% CI 1.02–1.86 p=0.035) with an AUC of 0.686. A Hb/Cr cutoff of 1.5 yielded 87.5% sensitivity to predict mortality
Conclusion
An increasing Hb/Cr ratio was associated with in-hospital mortality among first-time hemodialysis patients. In resource-limited, settings this inexpensive tool may help triage patients and guide resource allocation to improve outcomes. Although studies of myocardial infarction have shown different thresholds of Hb/Cr ratios associated with increased mortality we believe our findings differ due to higher Cr and lower Hb levels in our CKD population. The small sample warrants further investigation. To our knowledge, this is the first report on clinical outcomes in incident hemodialysis patients in Guatemala.