Analysis of adjudicated causes of death in a large cohort of Brazilian patients undergoing dialysis.

BACKGROUND

Patients with chronic kidney disease (CKD) undergoing dialysis have a high mortality risk. Cardiovascular and infectious events are the leading causes of death in this population; in Brazil, data on cause-specific mortality remain limited. Therefore, we analyzed the causes of death among patients treated within a national dialysis facility network.

METHODS

This retrospective study evaluated adjudicated causes of death between 2022 and 2024 across 32 Fresenius Medical Care facilities. During monthly meetings, deaths occurring in the previous month were reviewed at each facility, in the presence of the local medical director, head nurse, and two physicians from the national headquarters.

RESULTS

During the study period, 9763 patients underwent dialysis (96% hemodialysis/hemodiafiltration; 4% peritoneal dialysis). A total of 1994 deaths were recorded, of which 1742 were adjudicated and included in the analysis. At death, the median age was 72 years, 59% had diabetes, and the dialysis vintage was 37 months. Infection was the leading cause of death (41%), followed by cardiovascular disease (30%). Most deaths occurred in hospitals (84%), and only 2% in dialysis clinics; 52% were classified as unexpected. Compared with cardiovascular deaths, infection-related deaths occurred in older patients, more often in the hospital, and with longer hospital stays. Pneumonia (35%) and sudden death (37%) were the most common infection-related and cardiovascular causes, respectively.

CONCLUSION

In this large Brazilian dialysis cohort with adjudicated outcomes, infection was the leading cause of death, followed by cardiovascular disease. Structured, temporally framed mortality review meetings enabled systematic evaluation of deaths, contributing care processes, and patient safety.