• Vahid Ebrahimi, Mehrdad Sharifi, Mohammad Hossein Khademian, Peyman Jafari, Shahrokh Ezzatzadegan Jahromi, and Samaneh Sabouri.
• Department of Biostatistics, School of Medicine, Shiraz University of Medical Sciences, Shiraz, Iran.
• Arch Iran Med. 2021 Nov 1; 24 (11): 828-836.

BackgroundHemodialysis (HD) patients face long-term complications which require ongoing dialysis and follow-up. The management of hypertension among HD populations has often been neglected. This study aimed at identifying the determinants of death in hypertensive HD (HTN-HD) patients.MethodsIn a multicenter retrospective cohort study (conducted from 2005 to 2018 in thirty-four HD centers affiliated with Shiraz University of Medical Sciences), the data of 725 HTN-HD patients who had at least 3 months of regular dialysis and follow-up were analyzed. Accelerated failure time mixture split-population (AFTMSP) regression was utilized to identify the factors with significant effects on long- and short-term overall survival (OS) separately.ResultsAmong the different AFTMSP models, the extended generalized gamma (EGG) model outperformed the others. Sex (male: event time ratio [ETR]=1.30), initial vascular access type (arteriovenous fistula: ETR=1.50), and the type of membrane flux used for HD (high-flux: ETR=1.27) had important impacts on short-term OS. Moreover, age (OR=1.06), dialysis adequacy (Kt/ Vurea≤1.2: OR=2.30), initial vascular access type (central venous catheter: OR=2.08), serum sodium (OR=0.90) concentration, and potassium (OR=0.66) concentration had significant effects on long-term OS.ConclusionThe split-population analyses were able to demonstrate that the predictors of long-term OS were different from those of short-term OS. Although the superiority of the parametric EGG model was proved in this study, further research with different databases is suggested. Moreover, these findings can be considered by health policy decision-makers to create a new guideline to enhance the long-term OS of HTN-HD patients.© 2021 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

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