Achievement of guideline targets in elderly patients on hemodialysis: a multicenter study

Dimković, Nada; Djukanović, Ljubica; Marinković, Jelena; Djurić, Živka; Knežević, Violeta; Lazarevic, Tatjana; Ljubenovic, Stanimir; Marković, Rodoljub; Rabrenović, Violeta

doi:10.1007/s11255-015-1055-4

Cited by 4 publications

(6 citation statements)

References 38 publications

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“…The causes of ESRD, comorbidity, and risk factors for mortality differ between older and younger patients. 15 Older patients exhibited lower serum P, iPTH, and albumin levels and reduced protein intake compared with younger patients undergoing hemodialysis. 9 , 15 Results from previous studies supported the significant association between the markers of MBD and risks of both cardiovascular and all-cause death; however, cardiovascular deaths accounted for approximately 50% of the total deaths in the study.…”

Section: Discussionmentioning

confidence: 93%

“… 15 Older patients exhibited lower serum P, iPTH, and albumin levels and reduced protein intake compared with younger patients undergoing hemodialysis. 9 , 15 Results from previous studies supported the significant association between the markers of MBD and risks of both cardiovascular and all-cause death; however, cardiovascular deaths accounted for approximately 50% of the total deaths in the study. 3 , 16 Our study showed that cardiovascular death accounts for approximately one-third (36.8%) of total deaths in older patients undergoing MHD.…”

Section: Discussionmentioning

confidence: 93%

“…Furthermore, since the MBD parameters are interrelated, there may be bias in the observed effect estimates. 20 , 23 Although serum iPTH and P levels are typically lower in older patients, 9 , 15 a higher mortality risk has been reported for older patients. 10 …”

Section: Discussionmentioning

confidence: 99%

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Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing

Liu

Huang

et al. 2021

Therapeutic Advances in Endocrinology

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Background: The number of patients ⩾65 years who require maintenance hemodialysis (MHD) is increasing. Although reduced bone turnover in older patients receiving hemodialysis, as reflected by lower serum intact parathyroid hormone (iPTH) and phosphate (P) levels, has been reported, focus on the association between abnormal bone metabolism and the risk of death in older patients receiving MHD has been limited. Methods: We retrospectively examined data from the Beijing Hemodialysis Quality Control and Improvement Center for 1410 older patients who underwent hemodialysis from 1 January 2012 to 31 December 2016. Baseline, time-dependent (TD) Cox proportional hazards models and Kaplan–Meier analyses were used to evaluate the association between the markers of mineral and bone disorder (MBD) [calcium (Ca), P, and iPTH] and survival. The Kidney Disease: Improving Global Outcomes (KDIGO) target ranges were included as reference values. Results: Serum P levels >2.49 mmol/l increased the risk of all-cause death [hazard ratio (HR): 1.46; 95% confidence interval (CI): 1.04–2.07; p = 0.030] and cardiovascular death (HR: 2.01; 95%CI: 1.21–3.34; p = 0.007); iPTH levels >600 pg/ml increased the risk of cardiovascular death (HR: 1.95; 95%CI: 1.20–3.15; p = 0.007). Baseline results and TD Cox analyses were similar. All three MBD parameters were within the respective target ranges at least once during the follow-up period in 399 (28.3%) patients, and these patients had better survival rates than those who achieved two of the three target ranges (715/1410 patients; 50.7%); those who achieved one or no target range (296/1410; 21.0%) had the lowest survival rate (all-cause death: log-rank chi square = 83.96, p < 0.001; cardiovascular death: log-rank chi square = 47.06, p < 0.001). Conclusion: Older patients undergoing MHD who achieved the KDIGO target levels for any two or three MBD parameters had lower risks of all-cause and cardiovascular death.

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Section: Discussionmentioning

confidence: 93%

Section: Discussionmentioning

confidence: 93%

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Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing

Liu

Huang

et al. 2021

Therapeutic Advances in Endocrinology

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“…On the other hand, HD patients from Serbia were younger than those from Western Europe. This difference may influence achievement of guideline targets, as already mentioned [23]. …”

Section: Discussionmentioning

confidence: 98%

Association between Hemodialysis Patient Outcomes and Compliance with KDOQI and KDIGO Targets for Mineral and Bone Metabolism

Djukanović

Dimković²,

Marinković³

et al. 2016

Nephron

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Background: Increased mortality of hemodialysis (HD) patients is associated with chronic kidney disease-mineral and bone disorders (CKD-MBD), and therefore, their correction may improve patient survival. Differences in targets recommended by KDOQI and KDIGO CKD-MBD guidelines directed us to compare the relative numbers of patients achieving these targets and to examine possible associations between compliance with the targets and patient outcome. Methods: A total of 1,744 patients (61.2% males, aged 58.7 ± 12.5 years) dialyzed in 20 HD centers in Serbia were monitored for 3 years. The number of participants achieving KDOQI/KDIGO guideline targets for serum phosphorus, calcium, and iPTH was determined. The Cox proportional hazards model was used to select variables significantly associated with risk of time to death. Results: A majority of patients were dialyzed thrice weekly for 4 h; 86.3% of them used phosphate binders and 49.3% vitamin D3. Proportions of patients achieving KDOQI and KDIGO targets were 49.5 and 44.4% for phosphorus, 53.2 and 76.7% for calcium, 21 and 42.8% for iPTH. Multivariate Cox analysis selected serum phosphorus level outside the KDIGO target, as well as serum iPTH levels outside KDOQI and KDIGO targets as significant mortality predictors. Areas under the receiver operating characteristic curves showed that achievement of both guideline targets for iPTH had similar survival predictive values. Conclusion: Serum phosphorus levels outside KDIGO targets and iPTH levels outside both KDOQI and KDIGO targets were associated with a significantly higher risk of death. These findings may be useful in the management of CKD-MBD and for establishing local guidelines.

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“… 8 In addition, advanced age is associated with shorter survival in patients undergoing MHD. 9 Older patients are more likely to die of their primary disease when initiating dialysis and they are also more likely to experience various complications of dialysis. 10 Previous studies have also shown that advanced age and long-term dialysis are associated with the progression of MHD in patients.…”

Section: Introductionmentioning

confidence: 99%

The interaction analysis between advanced age and longer dialysis vintage on the survival of patients receiving maintenance hemodialysis

Huang

Zhang

et al. 2022

J Int Med Res

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Objective To compare the all-cause mortality of aged and younger patients undergoing maintenance hemodialysis (MHD) over the long or short term, and to identify independent risk factors. Methods We performed a retrospective cohort study using the medical records of 181 patients undergoing MHD. We compared the clinical characteristics and laboratory data of survivors and participants who died, according to their age and the duration of MHD. Binary stepwise logistic regression was used to identify independent risk factors for all-cause mortality. Results Cardiovascular and cerebrovascular diseases were the principal causes of mortality. The number of aged participants with hypertensive nephropathy as their primary kidney disease was significantly higher than the number of younger participants. The proportion with chronic glomerulonephritis was significantly higher for participants undergoing long-term MHD. Logistic regression analysis revealed that low body mass index, single-pool Kt/V, serum albumin, platelet count, and total iron-binding capacity; and high intact parathyroid hormone and N terminal pro B type natriuretic peptide were independent risk factors for all-cause mortality. Conclusions Aged patients are more susceptible to hypertensive nephropathy than younger patients. In addition, the survival of patients with chronic glomerulonephritis undergoing MHD is superior to that of those with hypertensive or diabetic nephropathy.

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Achievement of guideline targets in elderly patients on hemodialysis: a multicenter study

Cited by 4 publications

References 38 publications

Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing

Association between the risk of death and serum calcium, phosphate, and intact parathyroid hormone levels in older patients undergoing maintenance hemodialysis: a cohort study in Beijing

Association between Hemodialysis Patient Outcomes and Compliance with KDOQI and KDIGO Targets for Mineral and Bone Metabolism

The interaction analysis between advanced age and longer dialysis vintage on the survival of patients receiving maintenance hemodialysis

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