BACKGROUND: Traditional risk factors, such as high blood pressure, obesity and hypercholesterolemia, play an important role in the development of cardiovascular disease (CVD) in the general population. However, these traditional factors appear to be protective and associated with improved survival in patients on maintenance hemodialysis (MHD). Protein Energy Malnutrition (PEM) and inflammation, have also been implicated as the most powerful death indicators in MHD patients and a main cause of the reverse epidemiology. This study aims to determine whether this paradoxical association exists in patients on maintenance hemodialysis in two centers (Cardinal Santos Medical Center and Genesis Hemodialysis and Diagnostic Clinic) in Metro Manila.

METHODOLOGY: Data were taken from 864 patients' record pooled from the two centers from January 2007 - December 2009; 752 were excluded and 115 patients were eligible for the study. Age, gender, height, prehemodialysis blood pressure, serum albumin, total cholesterol, urea reduction ratio, hemoglobin, white blood cell count, lymphocytes, creatinine duration of hemodialysis and mortality data were extracted and subjected to statistical analyses. A subgroup analysis of BMI and prehemodialysis blood pressure was done. 5 categories of BMI were used based on the WHO BMI classification to group the patient according to BMI. 8 categories of systolic blood pressure 9from 180 mm Hg, with increments of 10 mm Hg) and 5 categories of diastolic blood pressure (from 100 mm Hg, with increments of 10 mm Hg) was patterned from the study by Kalantar-Zadeh, et. al. (2005) to group the group the patients according to their prehemodialysis BP.

RESULTS: The baseline characteristics of the population show that 61.7% were males. A cross-tabulation between genders using Pearson's chi-square shows that gender was not a significant risk factor for mortality. Yhe mean duration of hemodialysis was 22.3 + 13.3 in which 67.8% of the population died within 2 years of MHD. The mean BMI for both genders were similar. Majority of the population (82.5%) had cardiovascular disease and hypertension (57.4%) is the most common co-morbid condition. A comparison of means showed that only age (p-value