Clinical and Laboratory Factors Associated With Atherosclerotic Disease in Patients Receiving Maintenance Hemodialysis: A Cross-Sectional Study

Abstract Purpose Patients receiving maintenance hemodialysis (MHD) have a substantial burden of atherosclerotic disease, yet the relative contributions of conventional and dialysis-related factors remain incompletely characterized. We investigated clinical and laboratory factors associated with atherosclerotic disease in an MHD cohort. Methods We conducted a cross-sectional study of 113 patients receiving MHD at Baoshan Second People’s Hospital, Yunnan, China. Atherosclerotic disease was defined as documented coronary atherosclerotic disease, ischemic stroke/cerebral infarction, or lower-extremity arterial atherosclerotic plaque. Variables with P < 0.10 in univariable logistic regression were entered into an initial multivariable model, from which a parsimonious six-variable model was derived by backward elimination. Multicollinearity, linearity in the logit, influential observations, calibration, discrimination, and bootstrap internal validation were assessed. Results Atherosclerotic disease was present in 74 of 113 patients (65.5%). In the parsimonious model, age (adjusted odds ratio [aOR] 2.41, 95% confidence interval [CI] 1.48–3.91 per 10 years), diabetes (aOR 5.56, 95% CI 1.04–29.61), smoking (aOR 5.03, 95% CI 1.41–18.00), interdialytic weight gain (IDWG; aOR 1.89, 95% CI 1.27–2.82 per percentage point), alkaline phosphatase (ALP; aOR 1.14, 95% CI 1.01–1.29 per 10 U/L), and monocyte count (aOR 1.56, 95% CI 1.10–2.22 per 0.1×10^9/L) were independently associated with atherosclerotic disease. The apparent AUC was 0.867 and the optimism-corrected AUC was approximately 0.832 after 1,000 planned bootstrap resamples (978 successful fits). Conclusion Older age, diabetes, smoking, greater IDWG, higher ALP, and higher monocyte count were independently associated with atherosclerotic disease in this MHD cohort. These findings are hypothesis-generating and do not establish causality or constitute an externally validated prediction model. Larger prospective multicenter studies with standardized vascular ascertainment are warranted.