Long-Term Survival on Hemodialysis: A Multicenter Cohort Study From India

Background Chronic kidney disease (CKD) is a major healthcare challenge in India. Expansion of dialysis services without a functional registry leaves a critical gap in patient outcome data. Material and Methods This study evaluated the outcomes of a diverse cohort of patients undergoing maintenance hemodialysis (HD) treated at Apex Kidney Care (AKC), a major Indian dialysis service provider. A cohort of 24,775 patients receiving HD for >90 days between August 2008 and April 2025, at 288 centers across 16 states, was included. HD vintage was calculated from Day 0 and excluded patients who died or exited before Day 90. The primary outcome was patient survival, and factors affecting this were evaluated. Results Patient survival was 87.7% (95% CI, 87–88%) at 1 year and 58.2% (95% CI, 57–59%) at 5 years. The 5-year survival declined with advancing age: <45 years, 73% (95% CI, 72–75); 45–65 years, 61% (95% CI, 59–62); >65 years, 45% (95% CI, 42–49) ( p <0.001). Patients with diabetes formed 39.2% of the cohort and had lower age-adjusted 5-year survival (65% [95% CI 62–67]) compared to the rest (74% [95% CI 73-75], p <0.001). A multivariable Cox proportional hazards (PH) model indicated a 15% higher mortality for females ( p <0.001). Five-year survival was significantly higher for patients receiving >3 dialysis sessions weekly (81%) compared to those receiving <2 sessions (65%). Survival varied by center type (private 79%, public 72%), but center category was not a significant predictor in multivariable analysis ( p = 0.6 ). Conclusion This study establishes long-term survival outcomes for patients on HD in India, Frequency of dialysis emerged as the main dialysis-related factor associated with survival.