Abstract: 【Abstract】 Objective To analyze predictive factors for all-cause mortality, cardiovascular (CV) mortality and non-fatal CV events (CVE) in maintenance hemodialysis (MHD) patients, and to compare the effects of standard hemodialysis (HD) and online hemodiafiltration (HDF) on these factors and outcomes. Methods A total of 333 MHD patients were prospectively followed up for 50±15 months, and their all-cause death, CV death and CVE were registered. At the baseline, their demographic, clinical and laboratory data were recorded. Then the patients were stratified according to dialysis modalities into two groups, HD group (n = 268) and HDF group (n = 65). At the end of the 6th month, clinical and laboratory data were evaluated again. The predictive factors at baseline for all-cause mortality, CV mortality and CVE were analyzed by Cox regression. The effects of HD and HDF on these factors at the 6th month and on long-term outcome were compared by t-test and Kaplan-Meier method, respectively. Results Age (RR=1.041, P＜0.001), female gender (RR=0.615, P=0.020), left ventricular mass index (LVMI) (RR=1.011, P=0.006), aortic arch calcification score (AoACS) (RR=1.329, P=0.003), hemoglobin (Hb) ＜100 g/L (RR=2.609, P＜0.001), and ferritin >500 ng/ml (RR=1.637, P=0.037) were the independent predictive factors for all-cause mortality. C-reactive protein (CRP) (RR=1.093, P＜0.001), LVMI (RR=1.030, P＜0.001), aortic arch calcification score (AoACS) (RR=1.652, P＜0.001), and Hb ＜100 g/L (RR=2.144, P=0.016) were the predictive factors for CV mortality. Prior cardiovascular disease (CVD) (RR=3.408, P＜0.001), LVMI (RR=1.028, P＜0.001), and AoACS (RR=1.329, P=0.003) were the independent predictive factors for non-fatal CVE. In HDF group at the end of the 6th month, body mass index (BMI) (t=-2.494，P=0.013), body weight (t=-2.252, P=0.023), total serum cholesterol (t=-1.992, P=0.047), and Hb (t=-2.175, P=0.030) were higher, but CRP (t=6.432, P＜0.001), LVMI (t=2.420, P=0.017), and AoACS (t=2.337, P=0.020) were lower. In HDF group, all-cause mortality (χ2=9.610, P=0.002), CV mortality (χ2=4.533, P =0.033), and CVE (χ2=4.598, P
= 0.032) improved with longer survival time and better outcome. Conclusions Age, gender, LVMI, AoACS, Hb, and ferritin were the predictors for all-cause mortality in MHD patients. CRP, LVMI, AoACS, and Hb were associated with CV mortality. Prior CVD, AoACS and LVMI were the independent predictors for non-fatal CVE. HDF improved BMI, body weight, total serum cholesterol, Hb, CRP, LVMI, AoACS, and long-term outcome including all-cause mortality, CV mortality and non-fatal CVE.

Key words: Hemodialysis, Hemodiafiltration, Mortality, Aortic arch calcification, Left ventricular mass index