Mortality and associated risk factors between young and elderly maintenance haemodialysis patients: a multicentre retrospective cohort study in China

Abstract

ObjectivesMortality and associated risk factors in young and elderly haemodialysis patients with end-stage kidney disease (ESKD) have not been well examined in China. Therefore, we aimed to assess the all-cause mortality and risk factors associated with all-cause mortality between young and elderly haemodialysis patients in China.DesignA population-based multicentre retrospective cohort study.SettingUsing the Dialysis Initiation based on Fuzzy mathematics Equation study data, patients with ESKD undergoing maintenance haemodialysis from 24 centres in China from 1 January 2008 to 30 September 2015.Participants1601 enrolled patients with ESKD were categorised into young group (18–44 years old) and elderly (≥60 years old) group.Outcome measuresThe primary outcome was all-cause mortality. We estimated overall survival using a log-rank test. Cox proportional hazard regression analysis was implemented to identify risk factors and HR associated all-cause mortality.ResultsDuring a mean follow-up of 48.17±25.59 months, of the 1601 subjects, 319 (19.92%) patients death, including 64 (9.97%) in young group and 255 (26.59%) in elderly group, respectively. The cumulative survival in elderly group was lower than young group (Log Rank tests=63.31, p<0.001). Multivariate Cox proportional hazards analysis showed the cardiovascular disease (HR, 2.393; 95% CI 1.532 to 3.735; p<0.001), cerebrovascular disease (HR, 2.542; 95% CI 1.364 to 4.739; p=0.003) and serum albumin<3.5 g/dL (HR, 1.725; 95% CI 1.091 to 2.726; p=0.020) at the haemodialysis initiation were associated with increased risk of all-cause mortality in elderly groups; however, the cardiovascular disease only was associated with increased risk of all-cause mortality in young groups.ConclusionsThe all-cause mortality of elderly haemodialysis patients were higher than young haemodialysis patients in China. Identified risk factors associated all-cause mortality may inform development of age-appropriate treatment, intervention strategies and improve survival prognosis of this unique population.

Risk prediction models for cardiovascular events in hemodialysis patients: A systematic review

“…Elderly patients, due to decreased cardiac reserve and accompanying vascular stiffness, are more susceptible to various CV complications during HD. 30 Diabetes can trigger an inflammatory state, increase the generation of reactive oxygen species, and disrupt lipid metabolism, all of which significantly impact the long-term survival rate of HD patients, whether as a primary or comorbidity. 17 ALB level is an important indicator reflecting the body's nutritional status.…”

“…Age, history of diabetes, CRP, and ALB are the most common predictive factors for CV event risk in HD patients, suggesting that medical practitioners should pay attention to the warning role of these indicators in CV event prediction and strengthen their assessment. Elderly patients, due to decreased cardiac reserve and accompanying vascular stiffness, are more susceptible to various CV complications during HD 30 . Diabetes can trigger an inflammatory state, increase the generation of reactive oxygen species, and disrupt lipid metabolism, all of which significantly impact the long‐term survival rate of HD patients, whether as a primary or comorbidity 17 .…”

Retrospective comparison of postoperative dressing after eschar dermabrasion on paediatric scald wounds: Bacterial cellulose dressing and allogenic skin

“…Scald injuries are the primary cause of paediatric burns in China, accounting for no less than 80%. 1 , 2 , 3 Unlike flame or contact burns, scald injuries in children result from heated fluid flowing over skin surface and exhibit several distinct characteristics: (1) a map‐like shape with an irregular outline; (2) inconsistent wound depth, typically resulting in deep partial‐thickness burns in upper or central wound areas, and superficial partial‐thickness burns in lower or surrounding areas; and (3) specific regions are usually involved, such as the face, neck, groin and perineum. Eschar dermabrasion, initially reported in the 1960s, 4 is a highly effective technique for treating scald wounds in paediatric patients.…”