Survival and Quality of Life on Maintenance Hemodialysis: Results from a Multicenter Study

Background The Sree Narayandasji Santram Maharaj improving hemodialysis outcomes initiative (SNSMDS) is a prospective, multicenter observational study to assess patient survival and quality of life (QoL) of incident patients on maintenance hemodialysis (MHD). Materials and Methods The study population included patients with incident adult patients staring MHD between April 2019 and December 2022 from 30 dialysis centers across West, Central, and South India. QoL was measured using a detailed EuroQOL-5-Dimensional 3-Level (EQ5D3L) based questionnaire. Results A total of 1039 (728 males and 311 females) patients on MHD were enrolled; the mean age was 49.06 ± 14.96 years (Males: 48.92 ± 15.20 years, Females: 49.37 ± 14.36 years). The survival of a patient on MHD in the present cohort was 94.1%, 86.6%, 77.9%, 58.4%, and 47.1% at 4 months, 8 months, 1 year, 2 years, and 3 years, respectively. In univariate analysis, increasing age (HR 1.014(1.01-1.02), p <0.001) and presence of diabetes (HR 1.614(1.28-2.03), p <0.001) were significantly associated with poor survival, whereas well educated (HR 0.592(0.043-0.82), p =0.002) had increased survival. Multivariate regression analysis revealed 1.5% added risk of death with every year spent on MHD. Insignificant difference is observed in the EQ5D3L score at enrollment (6.47 ± 1.73), and at the end of median follow-up of 12 months (6.49 ± 1.65) ( p =0.837). Conclusion Incident patients on hemodialysis had a 1-year survival rate of 77.9% and a 3-year survival rate of 47.1%. Overall QoL among hemodialysis patients did not improve significantly despite dialysis.