Abstrakt

The survival rate of elderly hemodialyzed (HD) patients is commonly thought to be poor. In a prospective, single center, non-interventional, observational study, the cause of all-cause and cardiovascular (CV) and heart failure (HF) mortality in this patient group were examined and compared with a younger cohort (below 60 years). The study included 223 patients (90 women and 133 men) with age ranging from 34.5 to 75.0 years treated with HD. Median duration of HD was 70.0 months (24.0-120.0). Mortality data was collected over a period of six years. We divided patients into groups: <60 (n=123), ≥60 years (n=100), and with (n=33) and without DM type 2 (n=190). During a six-year follow-up, 100 patients (44.8%) died, including 83 (37.2%) patients who died due to CV reasons. Median follow-up was 2015.0 days (946.0-2463.0) with the median time to death of 1166.0 days (654.5-1631.0). The factors negatively affecting patients’ survival in univariate Cox regression analysis included for all-cause mortality were: inter-dialytic weight gain (IDWG) (hazard ratio [HR]=1.60; p=0.01), ultrafiltration (UF) rate (HR=3.63; p=0.012) for group <60 years; for CV death: UF rate (HR=4.20; p=0.03), DM (HR=5.11; p=0.002) for group <60 years; for HF death: mellitus type 2 (DM) (HR=2.93; p=0.027) for group ≥60 years). In a multivariate Cox regression analysis for patients <60 years, the UF rate was the only independent predictor of all-cause mortality (HR 3.63 (1.34-9.67); p=0.011). Both DM (HR 4.91 (1.71-14.10); p=0.003) and UF rate (HR 3.62 (1.04-12.61); p=0.044) were independent predictors of CV-related mortality in patients <60 years. The UF rate can be a simple, useful indicator of higher long-term all-cause and CV mortality in HD patients <60 years of age. Also, DM may be a predictor of CV–related mortality in younger HD patients.

Przypisy

• 1. Adler A., Casula A., Steenkamp R., Fogarty D., Wilkie M., Tomlinson L., Nitsch D., Roderick P., Tomson C.R.: Association between glycemia and mortality in diabetic individuals on renal replacement therapy in the U.K. Diabetes Care, 2014; 37: 1304-1311
  Google Scholar
• 2. Cabrera C., Brunelli S.M., Rosenbaum D., Anum E., Ramakrishnan K., Jensen D.E., Stalhammar N.O., Stefánsson B.V.: A retrospective, longitudinal study estimating the association between interdialytic weight gain and cardiovascular events and death in hemodialysis patients. BMC Nephrol., 2015; 16: 113
  Google Scholar
• 3. Cea Soriano L., Johansson S., Stefansson B., Rodriguez L.A.: Cardiovascular events and all-cause mortality in a cohort of 57,946 patients with type 2 diabetes: associations with renal function and cardiovascular risk factors. Cardiovasc. Diabetol., 2015; 14: 38
  Google Scholar
• 4. Charytan D.: Is left ventricular hypertrophy a modifiable risk factor in end-stage renal disease? Curr. Opin. Nephrol. Hypertens., 2014; 23: 578-585
  Google Scholar
• 5. de Jager D.J., Grootendorst D.C., Jager K.J., van Dijk P.C., Tomas L.M., Ansell D., Collart F., Finne P., Heaf J.G., De Meester J., Wetzels J.F., Rosendaal F.R., Dekker F.W.: Cardiovascular and noncardiovascular mortality among patients starting dialysis. JAMA, 2009; 302: 1782-1789
  Google Scholar
• 6. Di Lullo L., Floccari F., Polito P.: Right ventricular diastolic function in dialysis patients could be affected by vascular access. Nephron Clin. Pract., 2011; 118: c27-c261
  Google Scholar
• 7. Eckardt K.U, Gillespie I.A., Kronenberg F., Richards S., Stenvinkel P., Anker S.D., Wheeler D.C., de Francisco A.L., Marcelli D., Froissart M., Floege J., ARO Steering Committee: High cardiovascular event rates occur within the first weeks of starting hemodialysis. Kidney Int., 2015; 88: 1117-1125
  Google Scholar
• 8. Flythe J.E., Kimmel S.E., Brunelli S.M.: Rapid fluid removal during dialysis is associated with cardiovascular morbidity and mortality. Kidney Int., 2011; 79: 250-257
  Google Scholar
• 9. Foley R.N., Curtis B.M., Randell E.W., Parfrey P.S.: Left ventricular hypertrophy in new hemodialysis patients without symptomatic cardiac disease. Clin. J. Am. Soc. Nephrol., 2010; 5: 805-813
  Google Scholar
• 10. Ghaffar U., Easom A.K.: A quality improvement project: Strategies to reduce intradialytic hypotension in hemodialysis patients. Nephrol. News Issues, 2015; 29: 30
  Google Scholar
• 11. Go A.S., Chertow G.M., Fan D., McCulloch C.E., Hsu C.Y.: Chronic kidney disease and the risks of death, cardiovascular events, and hospitalization. N. Engl. J. Med., 2004; 351: 1296-1305
  Google Scholar
• 12. Henderson L.W.: Symptomatic intradialytic hypotension and mortality: an opinionated review. Semin. Dial., 2012; 25: 320-325
  Google Scholar
• 13. Kalantaer-Zadeh K., Regidor D.L., Kovesdy C.P., Van Wyck D., Bunnapradist S., Horwich T.B., Fonarow G.C.: Fluid retention is associated with cardiovascular mortality in patients undergoing longterm hemodialysis. Circulation, 2009; 119: 671-679
  Google Scholar
• 14. Kottgen A., Russell S.D., Loehr L.R., Crainiceanu C.M., Rosamond W.D., Chang P.P., Chambless L.E., Coresh J.: Reduced kidney function as a risk factor for incident heart failure: the atherosclerosis risk in communities (ARIC) study. J. Am. Soc. Nephrol., 2007; 18: 1307-1315
  Google Scholar
• 15. Kumar S., Bogle R., Banerjee D.: Why do young people with chronic kidney disease die early? World J. Nephrol., 2014; 3: 143-155
  Google Scholar
• 16. Kurita N., Hayashino Y., Yamazaki S., Akizawa T., Akiba T., Saito A., Fukuhara S.: Revisiting interdialytic weight gain and mortality association with serum albumin interactions: the Japanese dialysis outcomes and practice pattern study. J. Ren. Nutr., 2017; 27: 421-429
  Google Scholar
• 17. Leung K.C., Quinn R.R., Ravani P., MacRae J.M.: Ultrafiltration biofeedback guided by blood volume monitoring to reduce intradialytic hypotensive episodes in hemodialysis: study protocol for a randomized controlled trial. Trials, 2014; 15: 483
  Google Scholar
• 18. Ma L., Zhao S.: Risk factors for mortality in patients undergoing hemodialysis: a systemic review and meta-analysis. Int. J. Cardiol., 2017; 238: 151-158
  Google Scholar
• 19. Mavrakanas T.A., Sniderman A.D., Barré P.E., Vasilevsky M., Alam A.: High ultrafiltration rates increase troponin levels in stable hemodialysis patients. Am. J. Nephrol., 2016; 43: 173-178
  Google Scholar
• 20. Mc Causland F.R., Brunelli S.M., Waikar S.S.: Dialysis dose and intradialytic hypotension: results from the HEMO study. Am. J. Nephrol., 2013; 38: 388-396
  Google Scholar
• 21. Park J.I, Bae E., Kim Y.L., Kang S.W., Yang C.W., Kim N.H., Lee J.P., Kim D.K., Joo K.W., Kim Y.S., Lee H.: Glycemic control and mortality in diabetic patients undergoing dialysis focusing on the effects of age and dialysis type: A prospective cohort study in Korea. PLoS One, 2015, 10: e0136085
  Google Scholar
• 22. Pirkle J.L.Jr., Comeau M.E., Langefeld C.D., Russell G.B., Balderston S.S., Freedman B.I., Burkart J.M.: Effects of weight-based ultrafiltration rate limits on intradialytic hypotension in hemodialysis. Hemodial. Int. (in print)
  Google Scholar
• 23. Pun P.H.: The interplay between CKD, sudden cardiac death, and ventricular arrhythmias. Adv. Chronic Kidney Dis., 2014; 21: 480-488
  Google Scholar
• 24. Rhee J.J., Zheng Y., Montez-Rath M.E., Chang T.I., Winkelmayer W.C.: Associations of glycemic control with cardiovascular outcomes among US hemodialysis patients with diabetes mellitus. J. Am. Heart Assoc., 2017; 6: e005581
  Google Scholar
• 25. Sattar A., Argyropoulos C., Weissfeld L., Younas N., Fried L., Kellum J.A., Unruh M.: All-cause and cause-specific mortality associated with diabetes in prevalent hemodialysis patients. BMC Nephrol., 2012; 13: 130
  Google Scholar
• 26. Schneider C., Coll B., Jick S.S., Meier C.R.: Doubling of serum creatinine and the risk of cardiovascular outcomes in patients with chronic kidney disease and type 2 diabetes mellitus: a cohort study. Clin. Epidemiol., 2016; 8: 177-184
  Google Scholar
• 27. Shastri S., Sarnak M.J.: Cardiovascular disease and CKD: core curriculum 2010. Am. J. Kidney Dis., 2010; 56: 399-417
  Google Scholar
• 28. Sikole A., Nikolov V., Dzekova P., Stojcev N., Amitov V., Selim G., Asani A., Gelev S., Grozdanovski R., Masin G., Klinkmann H., Polenakovic M.: Survival of patients on maintenance hemodialysis over a twenty-year period. Prilozi, 2007; 28: 99-110
  Google Scholar
• 29. Soedamah-Muthu S.S., Fuller J.H., Mulnier H.E., Raleigh V.S., Lawrenson R.A., Colhoun H.M.: High risk of cardiovascular disease in patients with type 1 diabetes in the U.K.: a cohort study using the general practice research database. Diabetes Care: 2006; 29: 798-804
  Google Scholar
• 30. Stefánsson B.V., Brunelli S.M., Cabrera C., Rosenbaum D., Anum E., Ramakrishnan K., Jensen D.E., Stalhammar N.O.: Intradialytic hypotension and risk of cardiovascular disease. Clin. J. Am. Soc. Nephrol., 2014; 9: 2124-2132
  Google Scholar
• 31. US Renal Data System 2013 Annual Data Report. Am. J. Kidney Dis., 2014; 63(Suppl. 1): A7
  Google Scholar
• 32. Villar E., Remontet L., Labeeuw M., Ecochard R.: Effect of age, gender, and diabetes on excess death in end-stage renal failure. J. Am. Soc. Nephrol., 2007; 18: 2125-2134
  Google Scholar
• 33. Wong M.M., McCullough K.P., Bieber B.A., Bommer J., Hecking M., Levin N.W., McClellan W.M., Pisoni R.L., Saran R., Tentori F., Tomo T., Port F.K., Robinson B.M.: Interdialytic weight gain: trends, predictors, and associated outcomes in the international dialysis outcomes and practice patterns study (DOPPS). Am. J. Kidney Dis., 2017; 69: 367-379
  Google Scholar

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