Background: Patients on hemodialysis face a mortality risk eight times greater than the general population. While alcohol consumption is associated with increased mortality in the general population, its impact has not been studied in hemodialysis patients. This study aimed to assess the association between alcohol consumption and all-cause mortality in this population. Methods: The Diet-HD prospective cohort included adult patients undergoing hemodialysis in Europe and Argentina. Alcohol intake was assessed at baseline using a food frequency questionnaire and categorized as abstinent, occasional drinker (14 g/day). Participants were followed until death or discharge from the dialysis unit. The primary outcome was all-cause mortality; secondary outcomes were cardiovascular and non-cardiovascular mortality. We examined associations using Cox proportional hazards (PH) models as the primary analysis and Fine and Gray competing risks models as secondary analysis. Confounding by demographic, clinical and lifestyle factors was addressed using propensity score inverse probability weighting. Results: Among 7,917 participants, 4,097 (52%) were abstinent, 2981 (38%) were occasional drinkers, and 839 (11%) were regular drinkers. Wine accounted for the majority of alcohol intake, and mean consumption among regular drinkers was 26 g/day. Over a median follow-up of 4.0 (IQR = 1.6 – 4.8) years, 3,753 deaths (36%) occurred. In the weighted and adjusted Cox PH model, the hazard ratios for all-cause mortality were 0.96 (95% CI 0.87 – 1.06; P=0.46) and 1.05 (95% CI: 0.88 – 1.26; P=0.57) for occasional and regular drinkers indicating no significant association between all-cause mortality compared with non-drinkers. Similar findings were observed for cardiovascular and non-cardiovascular mortality sub-analyses. Conclusion: In this large cohort of adults receiving maintenance hemodialysis, low to moderate alcohol consumption was not associated with all-cause or cause-specific mortality. These findings may not apply to heavier drinking patterns, which were uncommon in this population.
Heitz et al. (2026) studied this question.