{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,1,16]],"date-time":"2026-01-16T05:02:58Z","timestamp":1768539778545,"version":"3.49.0"},"reference-count":36,"publisher":"Frontiers Media SA","license":[{"start":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T00:00:00Z","timestamp":1736208000000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":["frontiersin.org"],"crossmark-restriction":true},"short-container-title":["Front. Med."],"abstract":"<jats:sec><jats:title>Objectives<\/jats:title><jats:p>The annual growth in the population of maintenance hemodialysis (MHD) patients is accompanied by a trend towards younger age groups among new cases. Despite the escalating mortality risk observed in MHD patients, there remains a dearth of research focused on young and middle-aged individuals in this cohort, leading to a deficiency in specialized predictive instruments for this demographic. This research seeks to explore the critical determinants impacting mortality risk in young and middle-aged MHD patients and to construct a prediction model accordingly.<\/jats:p><\/jats:sec><jats:sec><jats:title>Methods<\/jats:title><jats:p>This study involved 127 young and middle-aged patients undergoing MHD in the Blood Purification Center of Chaohu Hospital of Anhui Medical University from January 2019 to January 2022. The follow-up period for each patient ended either at the time of death or on January 31, 2024. Participants were monitored to determine their survival status and categorized into two groups: those who survived (98 patients) and those who deceased (29 patients). Clinical data were gathered for analysis. Logistic regression was utilized to pinpoint independent risk factors for mortality among these patients. Subsequently, a nomogram was established to predict mortality risk. The efficacy of this model was assessed through the area under the receiver operating characteristic curve (AUC-ROC), alongside a calibration curve and the Hosmer\u2013Lemeshow test to examine its fit. Additionally, decision curve analysis (DCA) was conducted to ascertain the clinical relevance of the predictive model.<\/jats:p><\/jats:sec><jats:sec><jats:title>Results<\/jats:title><jats:p>The study incorporated 127 young and middle-aged patients undergoing MHD, with a mortality rate recorded at 22.83% (29 cases). A logistic regression analysis revealed that age, hemoglobin (HB), serum magnesium (Mg), neutrophil-to-lymphocyte ratio (NLR), and platelet-to-albumin ratio (PAR) were significant independent predictors of mortality among these patients. Utilizing these variables, a nomogram was developed to predict mortality risk, achieving an AUC of 0.899 (95% CI: 0.833\u20130.966). The model exhibited a specificity of 83.67% and a sensitivity of 82.76%, demonstrating substantial discriminative ability. The model\u2019s robustness was confirmed through internal validation with 1,000 bootstrap samples, yielding an AUC of 0.894 (95% CI: 0.806\u20130.949). The calibration curve closely aligned with the ideal curve, and the Hosmer\u2013Lemeshow goodness-of-fit test yielded a <jats:italic>\u03c7<\/jats:italic><jats:sup>2<\/jats:sup> value of 6.312 with a <jats:italic>p<\/jats:italic>-value of 0.612, verifying the model\u2019s high calibration accuracy. Additionally, the DCA indicated that the model provides a net benefit across a wide range of decision thresholds from 0 to 0.99, underscoring its clinical utility.<\/jats:p><\/jats:sec><jats:sec><jats:title>Conclusion<\/jats:title><jats:p>The nomogram developed from variables including age, HB levels, serum Mg, NLR, and PAR exhibits high levels of discrimination and calibration. This model effectively predicts mortality risk among young and middle-aged patients undergoing MHD, proving its clinical relevance.<\/jats:p><\/jats:sec>","DOI":"10.3389\/fmed.2024.1508485","type":"journal-article","created":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T08:03:11Z","timestamp":1736236991000},"update-policy":"https:\/\/doi.org\/10.3389\/crossmark-policy","source":"Crossref","is-referenced-by-count":3,"title":["A novel nomogram for predicting mortality risk in young and middle-aged patients undergoing maintenance hemodialysis: a retrospective study"],"prefix":"10.3389","volume":"11","author":[{"given":"Lei","family":"Sun","sequence":"first","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yue","family":"Zhang","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Xinliang","family":"Zuo","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Yongmei","family":"Liu","sequence":"additional","affiliation":[],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1965","published-online":{"date-parts":[[2025,1,7]]},"reference":[{"key":"ref1","doi-asserted-by":"publisher","first-page":"282","DOI":"10.1159\/000533674","article-title":"Development and validation of a nomogram for predicting all-cause mortality in patients with hemodialysis having pulmonary hypertension","volume":"13","author":"Wu","year":"2023","journal-title":"Cardiorenal Med"},{"key":"ref2","doi-asserted-by":"publisher","first-page":"393","DOI":"10.1186\/s12882-022-03020-1","article-title":"Prognostic value of the combination of neutrophil-to-lymphocyte ratio, monocyte-to-lymphocyte ratio and platelet-to-lymphocyte ratio on mortality in patients on maintenance hemodialysis","volume":"23","author":"Liao","year":"2022","journal-title":"BMC Nephrol"},{"key":"ref3","doi-asserted-by":"publisher","first-page":"e0287696","DOI":"10.1371\/journal.pone.0287696","article-title":"Combined evaluation of geriatric nutritional risk index and neutrophil to lymphocyte ratio for predicting all-cause and cardiovascular mortality in hemodialysis patients","volume":"18","author":"Wang","year":"2023","journal-title":"PLoS One"},{"key":"ref4","doi-asserted-by":"publisher","first-page":"1508","DOI":"10.1080\/0886022X.2021.1997762","article-title":"Nomogram for predicting 1-, 5-, and 10-year survival in hemodialysis (HD) patients: a single center retrospective study","volume":"43","author":"Ouyang","year":"2021","journal-title":"Ren Fail"},{"key":"ref5","doi-asserted-by":"publisher","first-page":"1975","DOI":"10.1016\/S0140-6736(14)61601-9","article-title":"Worldwide access to treatment for end-stage kidney disease: a systematic review","volume":"385","author":"Liyanage","year":"2015","journal-title":"Lancet"},{"key":"ref6","doi-asserted-by":"publisher","first-page":"e936092","DOI":"10.12659\/MSM.936092","article-title":"A retrospective study from a single center in China to develop a nomogram to predict one-year mortality in patients with end-stage renal disease who are receiving hemodialysis","volume":"28","author":"Yao","year":"2022","journal-title":"Med Sci Monit"},{"key":"ref7","doi-asserted-by":"publisher","first-page":"460","DOI":"10.1159\/000531267","article-title":"Relationship between dialysate bicarbonate concentration and all-cause mortality in hemodialysis patients","volume":"48","author":"Wan","year":"2023","journal-title":"Kidney Blood Press Res"},{"key":"ref8","doi-asserted-by":"publisher","first-page":"4939","DOI":"10.3760\/cma.j.cn115682-20230807-00413","article-title":"Current status and influencing factors of readiness for young and middle-aged hemodialysis patients to return to work","volume":"29","author":"Gong","year":"2023","journal-title":"Chin J Mod Nurs"},{"key":"ref9","doi-asserted-by":"publisher","first-page":"e97","DOI":"10.1016\/j.kisu.2020.09.001","article-title":"China Kidney Disease Network (CK-NET) 2016 annual data report","volume":"10","author":"Zhang","year":"2020","journal-title":"Kidney Int Suppl"},{"key":"ref10","doi-asserted-by":"publisher","first-page":"2258228","DOI":"10.1080\/0886022X.2023.2258228","article-title":"A high platelet-to-lymphocyte ratio predicts all-cause mortality and cardiovascular mortality in maintenance hemodialysis patients","volume":"45","author":"Zhang","year":"2023","journal-title":"Ren Fail"},{"key":"ref11","doi-asserted-by":"publisher","first-page":"A7","DOI":"10.1053\/j.ajkd.2019.01.001","article-title":"US renal data system 2018 annual data report: epidemiology of kidney disease in the United States","volume":"73","author":"Saran","year":"2019","journal-title":"Am J Kidney Dis"},{"key":"ref12","doi-asserted-by":"publisher","first-page":"A8","DOI":"10.1053\/j.ajkd.2022.02.001","article-title":"US renal data system 2021 annual data report: epidemiology of kidney disease in the United States","volume":"79","author":"Johansen","year":"2022","journal-title":"Am J Kidney Dis"},{"key":"ref13","doi-asserted-by":"publisher","first-page":"170","DOI":"10.1186\/s12882-023-03191-5","article-title":"Association between serum \u03b22-microglobulin levels and the risk of all-cause and cardiovascular disease mortality in Chinese patients undergoing maintenance hemodialysis","volume":"24","author":"Jin","year":"2023","journal-title":"BMC Nephrol"},{"key":"ref14","doi-asserted-by":"publisher","first-page":"2052","DOI":"10.1016\/S0140-6736(18)31694-5","article-title":"Forecasting life expectancy, years of life lost, and all-cause and cause-specific mortality for 250 causes of death: reference and alternative scenarios for 2016-40 for 195 countries and territories","volume":"392","author":"Foreman","year":"2018","journal-title":"Lancet"},{"key":"ref15","doi-asserted-by":"publisher","first-page":"709","DOI":"10.1016\/S0140-6736(20)30045-3","article-title":"Global, regional, and national burden of chronic kidney disease, 1990\u20132017: a systematic analysis for the Global Burden of Disease Study 2017","volume":"395","year":"2020","journal-title":"Lancet"},{"key":"ref16","doi-asserted-by":"publisher","first-page":"1328","DOI":"10.1177\/0960327116630353","article-title":"Intentional poisoning among elderly people-residents of a large urban agglomeration in Poland","volume":"35","author":"Piekarska-Wijatkowska","year":"2016","journal-title":"Hum Exp Toxicol"},{"key":"ref17","doi-asserted-by":"publisher","first-page":"E482","DOI":"10.15167\/2421-4248\/jpmh2020.61.3.1421","article-title":"Predictors of mortality among hemodialysis patients in Hamadan province using random survival forests","volume":"61","author":"Tapak","year":"2020","journal-title":"J Prev Med Hyg"},{"key":"ref18","doi-asserted-by":"publisher","first-page":"641","DOI":"10.55730\/1300-0144.5356","article-title":"Comparison of geriatric nutritional risk index and creatinine index in short-term mortality prediction in maintenance hemodialysis patients","volume":"52","author":"Ebin\u00e7","year":"2022","journal-title":"Turk J Med Sci"},{"key":"ref19","doi-asserted-by":"publisher","first-page":"2915","DOI":"10.1007\/s11255-023-03576-3","article-title":"The number of valvular insufficiency is a strong predictor of cardiovascular and all-cause mortality in hemodialysis patients","volume":"55","author":"Wei","year":"2023","journal-title":"Int Urol Nephrol"},{"key":"ref20","doi-asserted-by":"publisher","first-page":"2255686","DOI":"10.1080\/0886022X.2023.2255686","article-title":"Development and validation of a multivariate model for predicting heart failure hospitalization and mortality in patients receiving maintenance hemodialysis","volume":"45","author":"Tang","year":"2023","journal-title":"Ren Fail"},{"key":"ref21","doi-asserted-by":"publisher","first-page":"286","DOI":"10.3390\/diagnostics11020286","article-title":"A growth differentiation factor 15-based risk score model to predict mortality in hemodialysis patients","volume":"11","author":"Chang","year":"2021","journal-title":"Diagnostics"},{"key":"ref22","doi-asserted-by":"publisher","first-page":"2182615","DOI":"10.1080\/0886022X.2023.2182615","article-title":"C-reactive protein-to-albumin ratio and six-month mortality in incident hemodialysis patients","volume":"45","author":"Sant\u2019Ana","year":"2023","journal-title":"Ren Fail"},{"key":"ref23","doi-asserted-by":"publisher","first-page":"650","DOI":"10.1159\/000509309","article-title":"Changes in quality of life in older hemodialysis patients: a cohort study on dialysis outcomes and practice patterns","volume":"51","author":"Ishiwatari","year":"2020","journal-title":"Am J Nephrol"},{"key":"ref24","doi-asserted-by":"publisher","first-page":"369","DOI":"10.1111\/hdi.12759","article-title":"The relationship between serum magnesium levels and mortality in non-diabetic hemodialysis patients: a 10-year follow-up study","volume":"23","author":"Shimohata","year":"2019","journal-title":"Hemodial Int"},{"key":"ref25","doi-asserted-by":"publisher","first-page":"109","DOI":"10.1159\/000504601","article-title":"Hypomagnesemia and short-term mortality in elderly maintenance hemodialysis patients","volume":"6","author":"Lu","year":"2020","journal-title":"Kidney Dis"},{"key":"ref26","doi-asserted-by":"publisher","first-page":"1043","DOI":"10.1007\/s11255-019-02073-w","article-title":"Hypomagnesemia is not an independent risk factor for mortality in Japanese maintenance hemodialysis patients","volume":"51","author":"Mizuiri","year":"2019","journal-title":"Int Urol Nephrol"},{"key":"ref27","doi-asserted-by":"publisher","first-page":"174","DOI":"10.1038\/ki.2013.327","article-title":"Hypomagnesemia is a significant predictor of cardiovascular and non-cardiovascular mortality in patients undergoing hemodialysis","volume":"85","author":"Sakaguchi","year":"2014","journal-title":"Kidney Int"},{"key":"ref28","doi-asserted-by":"publisher","first-page":"3027","DOI":"10.26355\/eurrev_201805_15060","article-title":"Evaluation of the prognostic value of LMR, PLR, NLR, and dNLR in urothelial bladder cancer patients treated with radical cystectomy","volume":"22","author":"Rajwa","year":"2018","journal-title":"Eur Rev Med Pharmacol Sci"},{"key":"ref29","doi-asserted-by":"publisher","first-page":"313","DOI":"10.1186\/s12888-022-03963-7","article-title":"High neutrophil-to-lymphocyte ratio is a significant predictor of depressive symptoms in maintenance hemodialysis patients: a cross-sectional study","volume":"22","author":"Feng","year":"2022","journal-title":"BMC Psychiatry"},{"key":"ref30","doi-asserted-by":"publisher","first-page":"55","DOI":"10.24425\/fmc.2019.131380","article-title":"Neutrophil-to-lymphocyte ratio predicts long-term all-cause mortality in patients with chronic kidney disease stage 5","volume":"59","author":"Woziwodzka","year":"2019","journal-title":"Folia Med Cracov"},{"key":"ref31","doi-asserted-by":"publisher","first-page":"1272","DOI":"10.3390\/biomedicines10061272","article-title":"The predictive value of NLR, MLR, and PLR in the outcome of end-stage kidney disease patients","volume":"10","author":"Mure\u0219an","year":"2022","journal-title":"Biomedicines"},{"key":"ref32","doi-asserted-by":"publisher","first-page":"691","DOI":"10.2147\/TCRM.S320145","article-title":"High pretreatment platelet-to-albumin ratio predicts poor survival results in locally advanced nasopharyngeal cancers treated with chemoradiotherapy","volume":"17","author":"Haksoyler","year":"2021","journal-title":"Ther Clin Risk Manag"},{"key":"ref33","doi-asserted-by":"publisher","first-page":"991","DOI":"10.3390\/jcm13040991","article-title":"Are platelet-related parameters prognostic predictors of renal and cardiovascular outcomes in IgA nephropathy?","volume":"13","author":"S\u00e1gi","year":"2024","journal-title":"J Clin Med"},{"key":"ref34","doi-asserted-by":"publisher","first-page":"1359","DOI":"10.1080\/0886022X.2021.1977319","article-title":"Platelet-to-albumin ratio: a risk factor associated with technique failure and mortality in peritoneal dialysis patients","volume":"43","author":"Yang","year":"2021","journal-title":"Ren Fail"},{"key":"ref35","doi-asserted-by":"publisher","first-page":"8315","DOI":"10.2147\/IJGM.S389846","article-title":"Predictive value of platelet-to-albumin ratio (PAR) for the cardiac-associated acute kidney injury and prognosis of patients in the intensive care unit","volume":"15","author":"He","year":"2022","journal-title":"Int J Gen Med"},{"key":"ref36","doi-asserted-by":"publisher","first-page":"84","DOI":"10.5761\/atcs.oa.20-00090","article-title":"Preoperative platelet to albumin ratio predicts outcome of patients with non-small-cell lung cancer","volume":"27","author":"Guo","year":"2021","journal-title":"Ann Thorac Cardiovasc Surg"}],"container-title":["Frontiers in Medicine"],"original-title":[],"link":[{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1508485\/full","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,1,7]],"date-time":"2025-01-07T08:03:15Z","timestamp":1736236995000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.frontiersin.org\/articles\/10.3389\/fmed.2024.1508485\/full"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,1,7]]},"references-count":36,"alternative-id":["10.3389\/fmed.2024.1508485"],"URL":"https:\/\/doi.org\/10.3389\/fmed.2024.1508485","relation":{},"ISSN":["2296-858X"],"issn-type":[{"value":"2296-858X","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,1,7]]},"article-number":"1508485"}}