Association of Biochemical Parameters with Clinical Outcomes among Patients Undergoing Maintenance Hemodialysis

Background: Patients undergoing maintenance hemodialysis (MHD) face substantial morbidity from biochemical imbalances and symptom burden. However, the association between serial biochemical parameters and specific clinical outcomes remains incompletely characterized.
Objective: To evaluate the association between biochemical parameters and clinical outcomes among patients undergoing MHD over 12 months.
Methods: This prospective observational study included 97 patients on MHD. Biochemical parameters (hemoglobin, serum phosphate, calcium, intact PTH, albumin, CRP, and Kt/V) were measured at baseline, 6 months, and 12 months. Clinical outcomes assessed included pruritus (VAS score), muscle cramps, restless sleep, and dry skin. Univariate and multivariable regression analyses were performed to identify independent predictors of outcomes.
Results: Mean age was 58.2±12.4 years; 56.7% were female. Pruritus was present in 53.6% of patients. On multivariate analysis, lower hemoglobin (adjusted OR 0.68, 95% CI 0.48–0.96, p=0.03), higher phosphate (aOR 1.52, 95% CI 1.02–2.27, p=0.04), higher PTH (aOR 1.96, 95% CI 1.04–3.69, p=0.04), and lower albumin (aOR 0.41, 95% CI 0.18–0.93, p=0.03) independently predicted pruritus. Higher phosphate independently predicted muscle cramps (aOR 1.76, 95% CI 1.10–2.82, p=0.02). Lower albumin was associated with dry skin (β -0.41, p=0.003). Kt/V and CRP showed weaker associations.
Conclusion: Biochemical derangements, particularly hyperphosphatemia, elevated PTH, anemia, and hypoalbuminemia, are significantly associated with adverse clinical outcomes in MHD patients. Routine monitoring and targeted management of these parameters may improve symptom control.