Abstract: 【Abstract】Although hemodialysis (HD) can improve the life expectancy of end stage renal disease (ESRD) patients, the risk of death is still significantly higher in HD patients than in general population. The purpose of this study was to explore the cause of death and its related information in HD patients in the China Dialysis Outcomes and Practice Patterns Study (DOPPS). Methods DOPPS is an international, prospective and observational study. China participated in the DOPPS 5 study (2012～2015) and has completed the follow-up of the cohort. A total of 1,427 patients were enrolled in the China DOPPS 5 study. Their demographics,
primary cause of ESKD, comorbidities, dialysis prescription, laboratory examination results, and date, cause and other related information of death were recruited. The primary cause, date and place of death were then defined. Results A total of 1,427 HD patients were enrolled in the China DOPPS 5 study, including 473 cases in Beijing, 454 cases in Guangzhou and 500 cases in Shanghai. The average age of the patients was 59.4+14.9 years old, 55% were males, and 25.1% had diabetes. The mean follow-up period was 1.9 years (1.1, 2.1 years). During the follow-up period, 205 patients died, with the overall mortality of 14.4% and the annual average mortality of 8.8%. In the death patients, the median age was 70 (59, 79) years old, 56.1% were males, and the median dialysis vintage was 2.5 (1.0～5.0) years. The number of death patients in Beijing, Guangzhou and Shanghai were 67, 67 and 71 cases respectively, with the annual average mortality of 7.9%,10.0% and 8.6% respectively. The top three causes of death in HD patients were cerebrovascular events (19.3%, including ischemic stroke), congestive heart failure (18.2%) and pulmonary infection (11.6%); 105 cases died of cardiovascular diseases, accounting for 51.2% of the death patients. There were gender differences in the ranking of the main causes of death. In the died patients, 70.8% died in hospital and 27.0% died at home; HD treatment continued before death in 79.8% patients, and discontinued before death in 20.2%; 62.9% cases received
hospice care before death; the risk time of death in a day was within 10pm～6am. Conclusion In the China DOPPS 5 study, the average annual mortality was 8.8%. The main cause of death was cardiovascular events. Among the single cause of death, cerebrovascular events (including ischemic stroke), congestive heart failure and pulmonary infection were the most common causes of death, and the causes of death seemed to be gender different. The terminal stage was present in most death patients, and 1/4 of death happened at home. Without medical intervention, the risk time of death in a day was from late night to early morning.

Key words: Hemodialysis, Mortality, Hospice care, DOPPS