Dilek TORUN, Engin ONAN, Hasan MICOZKADIOĞLU, Rüya KOZANOĞLU, Nihan TEKKARIŞMAZ, Meriç YAVUZ ÇOLAK, Mehmet HABERAL
Turkish Journal of Nephrology - 2026;35(1):48-54
Background: Early mortality remains a critical challenge among incident hemodialysis (HD) patients, particularly within the first 90 days of treatment. Identifying modifiable predictors of mortality during this vulnerable period is essential for improving patient outcomes. Methods: This retrospective cohort study included 287 adult patients who initiated HD between January 2018 and December 2020. Demographic, clinical, and laboratory variables were analyzed to identify independent risk factors associated with all-cause mortality using multivariate logistic regression. Results: Over a mean follow-up of 13.2 months, 87 patients (30%) died, with 10% of deaths occurring within the first 90 days. Cardiovascular disease and infections were the leading causes of death. In the multivariate analysis, independent predictors of mortality were malignancy (odds ratio [OR]: 7.82; 95% confidence interval [CI]: 3.11-19.66), cardiovascular disease (OR: 3.54; 95% CI: 1.64-6.00), heart failure (OR: 2.04; 95% CI: 1.27-3.29), and elevated C-reactive protein (CRP >= 5 mg/L) (OR: 2.89; 95% CI: 1.54-5.44). Although initiating HD with a tunneled catheter was more common among non-survivors, it was not an independent predictor in the adjusted model. Conclusion: Early mortality in HD patients is strongly associated with systemic inflammation and cardiovascular burden. Malignancy, cardiovascular disease, heart failure, and elevated CRP levels emerged as significant independent predictors. These findings underscore the importance of early nephrology referral, inflammation control, and proactive vascular access planning. In addition to managing inflammation, early and systematic cardiovascular evaluation and malignancy screening may help further reduce early mortality in this high-risk population.
