Plasma Endothelin-1 as an Independent Predictor of Mortality in Vietnamese Hemodialysis Patients: A Prospective Cohort Study

Background: Endothelin-1 (ET-1) is a potent vasoconstrictor implicated in multiple complications of end-stage renal disease. This study evaluated the predictive value of baseline plasma ET-1 for 18-month all-cause mortality in Vietnamese hemodialysis patients. Methods: A prospective cohort study enrolled 222 patients on maintenance hemodialysis. Plasma ET-1 concentrations were quantified using an enzyme-linked immunosorbent assay (ELISA). The primary endpoint was 18-month all-cause mortality. Predictive accuracy was evaluated using receiver operating characteristic (ROC) curves, Kaplan–Meier survival analysis, and Cox proportional hazards regression models. Results: During the 18-month follow-up, 57 patients (25.68%) died. Non-survivors exhibited significantly higher median ET-1 levels compared to survivors (131.08 vs. 46.69 pg/mL, p < 0.001). The optimal ET-1 cutoff for predicting mortality was 85.06 pg/mL (area under the curve [AUC] = 0.875). Kaplan–Meier analysis demonstrated significantly worse survival in patients with ET-1 > 85.06 pg/mL (log-rank p < 0.001). In a multivariable Cox regression model adjusted for age, apparent treatment-resistant hypertension (aTRH), diabetes mellitus, and heart failure using a forward stepwise selection method, log2-transformed ET-1 remained a significant and independent predictor of all-cause mortality (hazard ratio [HR], 2.06; 95% confidence interval [CI], 1.52–2.79; p < 0.001). Conclusions: Baseline plasma ET-1 was independently associated with 18-month all-cause mortality in this single-center cohort of Vietnamese patients receiving maintenance hemodialysis. External validation is required before ET-1 can be recommended for routine clinical risk stratification.