The dynamics of prognostic indicators: toward earlier identification of dialysis patients with a high risk of dying.

Mortality remains stubbornly high in patients receiving chronic dialysis treatment. Identifying at-risk patients is essential for implementation of supportive therapies. The Monitoring Dialysis Outcomes (MONDO) database shows that in 40,000 dialysis patients worldwide who died, systolic blood pressure, interdialytic weight gain, and serum albumin declined progressively, and C-reactive protein increased more than 12 months before death, indicating that predictive models may be developed to enable nephrologists to improve the clinical outcome of dialysis patients.