High Cardiometabolic Index Linked to Higher Death Risk in Dialysis Patients: Study
China: A higher cardiometabolic index (CMI) is linked to a significantly increased risk of cardiovascular and all-cause mortality among patients undergoing dialysis, a new retrospective cohort study published in BMC Nephrology has found. The findings highlight the potential value of CMI as a simple clinical marker for identifying high-risk individuals in the dialysis population.
The study was conducted by Zhenhui Li from the Department of Nephrology and the Blood Purification Research Center at The First Affiliated Hospital of Fujian Medical University, Fuzhou, China, along with colleagues. While CMI—a composite indicator derived from lipid parameters and measures of central obesity—has been associated with adverse outcomes in the general population, its prognostic significance in patients receiving dialysis has not been well studied.
To address this gap, the researchers analyzed data from patients undergoing maintenance hemodialysis (MHD) or maintenance peritoneal dialysis (MPD) between January 2022 and June 2025. A total of 551 patients were included in the analysis. CMI values were measured at the start of follow-up, and participants were divided into three groups (tertiles) based on their baseline CMI levels.
The investigators used multiple statistical approaches to assess outcomes. Kaplan–Meier survival curves were applied to compare survival differences across the three CMI groups, while restricted cubic spline (RCS) models were used to explore the relationship between increasing CMI and mortality risk. Subgroup analyses were also performed to identify and validate potential risk modifiers.
The analysis revealed the following findings:
- There was a clear, graded relationship between higher cardiometabolic index (CMI) levels and poorer clinical outcomes.
- Cardiovascular mortality increased progressively across CMI tertiles, rising from 13% in the lowest tertile to 19% in the middle tertile and 35% in the highest tertile.
- All-cause mortality showed a similar stepwise increase, from 15% in the lowest CMI group to 27% in the middle group and 50% in the highest group.
- The increasing trends in both cardiovascular and all-cause mortality across CMI tertiles were statistically significant.
- Higher CMI levels were independently associated with an increased risk of mortality.
- Each incremental rise in CMI was linked to more than a twofold increase in the risk of all-cause mortality.
- The risk of cardiovascular death also increased significantly with higher CMI levels.
- These associations remained robust even after adjustment for multiple potential confounding factors, supporting CMI as an independent predictor of adverse outcomes in patients undergoing dialysis.
The findings were consistent across different patient subgroups, including those receiving hemodialysis and peritoneal dialysis, strengthening the robustness of the results. According to the authors, the observed relationship may reflect the combined effects of dyslipidemia and central obesity on inflammation, insulin resistance, and atherosclerosis—pathways already known to contribute to high cardiovascular risk in patients with end-stage kidney disease.
In conclusion, the study demonstrates that elevated CMI is closely associated with increased cardiovascular and all-cause mortality among patients undergoing dialysis. The authors suggest that routine assessment of CMI could help clinicians identify high-risk individuals and guide more personalized risk stratification and management strategies in this vulnerable population.
Reference:
Li, Z., Chen, H., Hong, B. et al. Elevated cardiometabolic index is associated with an increased risk of cardiovascular and all-cause mortality in patients undergoing dialysis: a retrospective cohort study. BMC Nephrol (2026). https://doi.org/10.1186/s12882-026-04778-4
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