Elevated cardiometabolic index is associated with an increased risk of cardiovascular and all-cause mortality in patients undergoing dialysis: a retrospective cohort study

BACKGROUND: Few studies have explored the relationship between cardiometabolic index (CMI) and the risk of death from dialysis. This study aimed to investigates whether the CMI values correlates with cardiovascular and all-cause mortality in patients undergoing dialysis. The study population included patients undergoing maintenance hemodialysis (MHD) and maintenance peritoneal dialysis (MPD). METHOD: This retrospective cohort study included patients undergoing dialysis (MHD and MPD) from January 2022 to and June 2025. Patients were divided into tertiles based on the CMI measured at the start of follow-up. Restricted Cubic Splines (RCS) were used to model the association between elevated CMI and the risk of adverse outcomes. The Kaplan-Meier curve was used to compare survival differences among the three groups. Additionally, a subgroup analysis identified and confirmed the risk factors. RESULTS: A total of 551 patients were included in this study. The risks of cardiovascular and all-cause mortality increased gradually across the CMI tertiles (13%, 19%, and 35% for cardiovascular mortality; 15%, 27%, and 50% for all-cause mortality; trend p < 0.001). RCS analysis was used to evaluate the association between elevated CMI and the risk of adverse outcomes. As CMI increased, the risk of all-cause mortality showed a significant increase (hazard ratio [HR] = 2.16, p < 0.001), as did the risk of cardiovascular mortality (HR = 1.82, p < 0.001) among all dialysis patients. After adjusting for various potential confounders, CMI remained a risk factor for cardiovascular and all-cause mortality among patients undergoing dialysis. CONCLUSION: Increased CMI was positively correlated with a higher risk of cardiovascular mortality and all-cause mortality in patients undergoing dialysis.