Fahad Saeed1, Susana Arrigain2,3, Jesse D Schold2,3, Joseph V Nally3, Sankar Dass Navaneethan4,5. 1. Department of Medicine and Public Health Sciences, Divisions of Nephrology and Palliative Care, University of Rochester Medical Center, Rochester, New York, USA, fahadsaeed20@gmail.com. 2. Department of Quantitative Health Sciences, Cleveland Clinic, Cleveland, Ohio, USA. 3. Department of Nephrology and Hypertension, Glickman Urological and Kidney Institute, Cleveland Clinic, Cleveland, Ohio, USA. 4. Selzman Institute for Kidney Health, Section of Nephrology, Department of Medicine, Baylor College of Medicine, Houston, Texas, USA. 5. Section of Nephrology, Michael E. DeBakey Veterans Affairs Medical Center, Houston, Texas, USA.
Abstract
BACKGROUND: Prognostic factors after dialysis initiation among older chronic kidney disease (CKD) patients are not well studied. In this study, we examined the risk factors associated with 1-year mortality after dialysis initiation among older CKD patients. METHODS: In this retrospective study, we included 621 CKD patients from an electronic medical record based CKD registry that was linked to the United States Renal Data System data. In terms of age, they were all ≥65. We examined the associations of various demographic factors, comorbid conditions, relevant laboratory parameters, the presence of arteriovenous fistula, and inability to take care of oneself with 1-year mortality after dialysis initiation using Cox proportional hazards model. RESULTS: In our study cohort, 224 older patients died during the first year of dialysis initiation and the estimated survival at 1 year was 65% (95% CI 62-69). After adjusting for covariates, increasing age by each year (Hazard ratio 1.04 [95% CI 1.02-1.06]), congestive heart failure (CHF; 1.57 [1.13-2.18]), an absence of AVF (3.0 [1.7-5.1]) and lack of nephrology care prior to dialysis initiation (1.93 [1.39-2.70]) were associated with increased risk of 1-year mortality. Nearly 60% of deaths were due to non-cardiovascular (CV) causes including cancer. CONCLUSION: Risk factors portending high 1-year mortality in older CKD patients are increasing age, CHF, an absence of AVF, and lack of pre-dialysis nephrology care. Clinicians need to be aware of non-CV risks of high mortality in these patients.
BACKGROUND: Prognostic factors after dialysis initiation among older chronic kidney disease (CKD) patients are not well studied. In this study, we examined the risk factors associated with 1-year mortality after dialysis initiation among older CKDpatients. METHODS: In this retrospective study, we included 621 CKDpatients from an electronic medical record based CKD registry that was linked to the United States Renal Data System data. In terms of age, they were all ≥65. We examined the associations of various demographic factors, comorbid conditions, relevant laboratory parameters, the presence of arteriovenous fistula, and inability to take care of oneself with 1-year mortality after dialysis initiation using Cox proportional hazards model. RESULTS: In our study cohort, 224 older patients died during the first year of dialysis initiation and the estimated survival at 1 year was 65% (95% CI 62-69). After adjusting for covariates, increasing age by each year (Hazard ratio 1.04 [95% CI 1.02-1.06]), congestive heart failure (CHF; 1.57 [1.13-2.18]), an absence of AVF (3.0 [1.7-5.1]) and lack of nephrology care prior to dialysis initiation (1.93 [1.39-2.70]) were associated with increased risk of 1-year mortality. Nearly 60% of deaths were due to non-cardiovascular (CV) causes including cancer. CONCLUSION: Risk factors portending high 1-year mortality in older CKDpatients are increasing age, CHF, an absence of AVF, and lack of pre-dialysis nephrology care. Clinicians need to be aware of non-CV risks of high mortality in these patients.
Authors: Harriet L Mather; Heather Coats; Kristen Desanto; J Nicholas Dionne-Odom; Cardinale B Smith; Laura P Gelfman Journal: J Palliat Med Date: 2019-04 Impact factor: 2.947
Authors: Gwen M Bernacki; Cara L McDermott; Daniel D Matlock; Ann M O'Hare; Lyndia Brumback; Nisha Bansal; James N Kirkpatrick; Ruth A Engelberg; Jared Randall Curtis Journal: J Pain Symptom Manage Date: 2021-08-04 Impact factor: 3.612