Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease

Abstract

IMPORTANCE Cardiovascular disease (CVD) is a leading cause of death among patients with end-stage renal disease (ESRD). Young adult (ages 22-29 years) have risks for ESRD-associated CVD that may vary from other ages. OBJECTIVE To test the hypothesis that young adult-onset ESRD is associated with higher cardiovascular (CV) hospitalizations and mortality with different characteristics than childhood-onset disease. DESIGN, SETTING, AND PARTICIPANTS This population-based cohort study used the US Renal Data System to categorize patients who initiated ESRD care between 2003 and 2013 by age at ESRD onset (1-11, 12-21, and 22-29 years). Cardiovascular hospitalizations were identified via International Classification of Diseases, Ninth Revision discharge codes and CV mortality from the Centers for Medicare & Medicaid ESRD Death Notification Form. Patients were censored at death from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014. Adjusted proportional hazard models (95% CI) were fit to determine risk of CV hospitalization and mortality by age group. Data analysis occurred from May 2016 and December 2017. EXPOSURES Onset of ESRD. MAIN OUTCOMES AND MEASURES Cardiovascular mortality and hospitalization. RESULTS A total of 33 156 patients aged 1 to 29 years were included in the study population. Young adults (aged 22-29 years) had a 1-year CV hospitalization rate of 138 (95% CI, 121-159) per 1000 patient-years. Young adults had a higher risk for CV hospitalization than children (aged 1-11 years; hazard ratio [HR], 0.41 [95% CI, 0.26-0.64]) and adolescents (aged 12-21 years; HR, 0.86 [95% CI, 0.77-0.97]). Of 4038 deaths in young adults, 1577 (39.1%) were owing to CVD. Five-year cumulative incidence of mortality in this group (7.3%) was higher than in younger patients (adolescents, 4.0%; children, 1.7%). Adjusted HRs for CV mortality were higher for young adults with all causes of ESRD than children (

Risk factors and antihypertensive medications for mortality in elderly hospitalized hemodialysis patients: a multicenter retrospective study in China

“…The high hospitalization rate not only aggravates the financial burden and psychological pressure of elderly hemodialysis patients, but also greatly increases the mortality rate [7]. We found that the proportion of secondary kidney diseases such as diabetes and hypertension in elderly hemodialysis patients was high, which is consistent with the results of other studies [8][9]. The incidence of anemia and hypoalbuminemia was high in elderly hemodialysis patients.…”

Developing Consensus-Based Outcome Domains for Trials in Children and Adolescents With CKD: An International Delphi Survey

“…23 Other outcomes that were thought to be potentially life-threatening or with a high burden of treatment, such as infection, cardiovascular disease, or blood pressure problems, were also prioritized highly by all groups. Infection is also the most frequent cause of hospitalization in patients requiring KRT, [29][30][31][32][33][34][35] which may explain the higher prioritization of this outcome. Other outcomes such as anemia, bone health, growth, and pain may have been indicated to be of relatively lower priority because they were perceived to be less life-threatening or because patients did not experience related symptoms.…”

Trends in Cardiovascular Mortality Among a Cohort of Children and Young Adults Starting Dialysis in 1995 to 2015

“…6 We included individuals as old as 30 years at time of dialysis initiation because prior studies have used this upper limit when focusing on young adult populations. 7 …”