Reports from a United States cohort of chronic hemodialysis patients that weight loss, a decline in pre-dialysis systolic blood pressure, and decreased serum albumin may precede death. However, no comparative been reported in such patients from other countries. Here we analyzed changes in these parameters in hemodialysis patients and included 3593 individuals from 5 Asian countries; 35,146 from 18 European countries; Argentina; and 4742 from the United States. In surviving prevalent these variables appeared to have notably different dynamics than in died. While in all populations the interdialytic weight gain, systolic pressure, and serum albumin levels were stable in surviving patients, indicators declined starting more than a year ahead in those who died dynamics similar irrespective of gender and geographic region. In patients, C-reactive protein levels were available on a routine basis indicated that levels of this acute-phase protein were low and stable in surviving patients but rose sharply before death. Thus, relevant biological processes start many months before death in the majority of hemodialysis patients. Longitudinal monitoring of these dynamics may identify patients at risk and aid the development of an alert system to timely interventions to improve outcomes.Kidney International advance publication, 20 March 2013; doi:10.1038/ki.2013.73.