Effect of cardiovascular risk factors and time of hospital presentation on mortality of maintenance hemodialysis patients presenting with acute pulmonary edema

Acute pulmonary edema (APE) has a poor prognosis in the general population. Mortality associated with APE in patients with end-stage renal disease (ESRD) is especially high, although specific predictors are not well understood. This study aimed to determine the potential predictive factors of outcome in patients with ESRD presenting with APE. Sixty-eight patients with ESRD (mean age, 68.9 ± 9.9 years; males, 66.2%; median duration of maintenance hemodialysis, 55.5 months) presenting with APE to a single tertiary medical center were retrospectively evaluated. The effects of patients’ characteristics, cardiovascular risk factors, variables at hospital presentation, and clinical presentation patterns on all-cause mortality were evaluated. Throughout the observational period (median follow-up period, 575 days; range, 10–2546 days), 32 (47%) patients died. In univariate analysis, older age, diabetes mellitus, peripheral artery or aortic disease, hypotension, atrial fibrillation rhythm, anemia, and hypoalbuminemia were associated with higher mortality, whereas hospital presentation from midnight to 8 am was associated with lower mortality. In multivariate analysis, age (hazard ratio (HR) = 1.05, 95% confidential interval (CI) 1.01–1.09, p = 0.018), presence of peripheral artery or aortic disease (HR = 3.36, 95% CI 1.52–7.42, p = 0.003), time of presentation from midnight to 8 am (HR = 0.40, 95% CI 0.15–0.99, p = 0.047), and atrial fibrillation rhythm at presentation (HR = 3.12, 95% CI 1.04–9.13, p = 0.044) were significantly independently associated with mortality. Our findings indicate important predictive roles of the clinical presentation pattern specific to ESRD patients, as well as their characteristics, including cardiovascular risk factors.