Age-Related Changes in Clinical and Analytical Variables in Chronic Hemodialyzed Patients

Abstract

Worldwide, the number of elderly individuals receiving chronic hemodialysis is rising. The aim of our study was to evaluate several clinical and analytical biomarkers in chronically dialyzed patients and analyze how they change with age. A cross-sectional study was performed by evaluating 289 end-stage renal disease patients undergoing dialysis. We evaluated the hemogram, adipokines, the lipid profile, and several markers related to inflammation, endothelial function/fibrinolysis, nutrition, iron metabolism, and cardiac and renal fibrosis. Clinical data and dialysis efficacy parameters were obtained from all patients. The relationships between studied biomarkers and age were assessed by a statistical comparison between younger (adults with age < 65 years) and older (age ≥ 65 years) patients and by performing regression analysis. Participants presented a mean age of 68.7 years (±13.6), with 66.8% (n = 193) being classified as older. Compared to younger patients, older patients presented the following: (a) significantly lower values of diastolic blood pressure (DBP) and ultrafiltration volume; (b) lower levels of phosphorus, uric acid, creatinine, and albumin; and (c) higher circulating concentrations of tissue-type plasminogen activator (tPA), D-dimer, interleukin-6, leptin, N-terminal pro B-type natriuretic peptide, and tissue inhibitor of metalloproteinase-1. In the multiple linear regression analysis, DBP values, tPA, phosphorus, and D-dimer levels were independently associated with the age of patients (standardized betas: −0.407, 0.272, −0.230, and 0.197, respectively; p < 0.001 for all), demonstrating relevant changes in biomarkers with increasing age at cardiovascular and nutritional levels. These findings seem to result from crosstalk mechanisms between aging and chronic kidney disease.

Age‐Related Reduction of D‐Dimer Cut‐Off Level Specificity: Diagnostic Relevance in Geriatric Patients

“…As also demonstrated in this paper, D dimer levels increase significantly with age, independently of sex and the presence of PE. Our results are in line with several papers that have shown an increase in D-dimer with age, not only for events related to venous thromboembolism, but also for different reasons (infections, neoplasms, immobilization, DIC, stroke, heart failure, renal disease, thrombolytic therapy etc...) [21][22][23][24][25]. The peculiarity of our study is that only few papers have considered DD in a such elderly patient population (74% of patients are over 80 years of age) [22,28,29].…”

“…As D-dimer levels are physiologically higher in elderly patients, D-dimer test loses clinical specificity. Alternatively to the classical cut-off level of 500 μg/L FEU, to improve the clinical specificity of Ddimer, other cut-off levels have been proposed: i.e an age adjusted DD cut-off level [ADC = (patient's age x 0.01)μg/ml] [21,22], a fixed cut-off value of 750 μg/L in patients aged 60 years and older who were referred to secondary care with symptoms of DVT [23] and a cut-off value of 1000 μg/L for those aged >60 years, using the Vidas D-dimer assay [24,25]. It became challenging to perform the right diagnosis in patients who were admitted to the Geriatric Emergency Care Department (GECD) with suspected VTE and who had concomitantly a wide spectrum of comorbidities associated with increased DD levels.…”