A new survival prediction model and exploration of hemodialysis quality control indicators in incident hemodialysis patients

Objective: To develop and internally validate a Cox model predicting 1.5-year adverse outcomes (cardiovascular admission or all-cause mortality) in incident hemodialysis (HD) patients by integrating routinely recorded dialysis-machine parameters with traditional indicators. Methods: We retrospectively analyzed 74 incident end-stage renal disease (ESRD) patients who commenced thrice-weekly HD at Huashan Hospital, Fudan University, between 2012 and 2018. A total of 83 candidate variables, including demographics, traditional indicators (Kt/V, phosphorus, parathyroid hormone [PTH], albumin, hemoglobin, ultrafiltration volume), and dialysis machine parameters, were evaluated. Univariable and multivariable Cox regression identified predictors of 1.5-year outcomes. Results: The mean (± SD) age of the study population was 62 ± 14 years, and 55.4% were male. Independent predictors included serum alkaline phosphatase (ALP) measured at month 3 and machine-derived bicarbonate conductivity (BC) at month 6. A model combining ALP (month 3), bicarbonate conductivity (month 6), and traditional indicators (month 6) showed strong discrimination (AUC = 0.82). Achieving targets in ≥5 of 8 indicators—including ALP and BC—was associated with significantly better outcomes (log-rank p = 0.018). Conclusion: Integrating ALP and machine-derived BC into a Cox model significantly improves risk stratification in incident HD patients and facilitates the implementation of automated quality control.