First-year mortality in incident dialysis patients: results of the Peridialysis study

Heaf, James; Heiro, Maija; Petersons, Aivars; Vernere, Baiba; Povlsen, Johan V.; Clyne, Naomi; Bumblytė, Inga Arūnė; Zilinskiene, Alanta; Randers, Else; Løkkegaard, Niels; Rosenberg, Mai; Kjellevold, Stig Arne; Kampmann, Jan; Rogland, Björn; Lagreid, Inger; Heimbürger, Olof; Lindholm, Bengt

doi:10.21203/rs.3.rs-362169/v1

Cited by 2 publications

(2 citation statements)

References 35 publications

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“…Despite the considerable proportion of health care resources being used, morbidity and mortality remain high in end-stage kidney disease (ESKD) patients especially during the first months on dialysis therapy. [1][2][3] Comorbidity and frailty, both frequent in elderly patients with chronic kidney disease (CKD), are associated with a higher risk of death even irrespective of age and dialysis need. [4][5][6][7] Frailty is a measure of increased vulnerability to stressful situations caused by reduced functional biological reserves.…”

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confidence: 99%

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Fernandes¹

2023

MOJGG

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Background: Mortality in end-stage kidney disease (ESKD) remains high, especially among the elderly with a higher burden of comorbidity and frailty. In this group, dialysis may not offer better survival compared to conservative management. Frailty defined by clinical frailty scale (CFS) and comorbidity by Charlson Comorbidity Index (CCI) are known independent predictors of mortality. Our aim was to compare which one had higher impact on early mortality in urgent-start hemodialysis patients. Methods: We conducted a retrospective cohort study of patients aged 65 years and over, who started hemodialysis as their first renal replacement therapy (RRT) between January 2014 and December 2020. CFS and mCCI, at time of HD start, were used to evaluate, respectively, frailty and comorbid disease burden. The primary outcome was death in the first 6 months of RRT. Results: During the study period 166 patients were included. The median age, at time of hemodialysis start, was 75 years ± 6.3 years. The mortality at 6 months was 19% (n=31). For both scales, the analysis of ROC curve, stablished the optimal cut-off to predict the event death at first 6 months as ≥ 5points. The performance of CFS was superior to the mCCI, in fact, the area under the curve was significantly higher in CFS (0.739) versus the mCCI (0.620). A CFS≥5 had a sensitivity/specificity of 94%/44% in prediction the primary outcome. On the other hand, a mCCI≥5 predicts the same outcome with a sensitivity/specificity of 26%/88%. The diagnostic odds ratio for CFS≥5 was 11.6, compared to only 2.7 for mCCI≥5. Lastly, we constructed a model in which both scores interacted (as categorical variables), which after multivariable adjustment showed that mCCI/CFS <5/≥5 and ≥5/≥5 were independent predictors of mortality (HR=7.06; P=0.017; HR=10.708; P=0.002; respectively). Interestingly, no events were observed in the mCCI≥5/CFS<5 group. Conclusions: In this cohort of urgent-start incident HD patients, frailty defined by CFS was a stronger predictor of mortality than comorbidity defined by CCI.

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Section: Introductionmentioning

confidence: 99%

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Fernandes¹

2023

MOJGG

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“…Hemodialysis is an important technology implicated in reducing risks of morbimortality and saving the lives of patients with progressive renal failure. However, it is still suboptimal and contributes to the chronic systemic inflammatory state (5).…”

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Serum Interleukin-6 is associated with hypocalcemia, hypoferritinemia and hyperkalemia in end-stage renal disease patients

Alubaidi

Humadi²,

Hamoodi³

et al. 2023

Ital J Med

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Background: Both of chronic inflammation and mineral disturbance are major concerns in patients with chronic kidney disease, particularly end-stage renal disease (ESRD). Objectives: The present study aimed to investigate the association between circulating IL-6 and minerals dysregulation in patients diagnosed with ESRF and on a continuous hemodialysis regimen. Methods: This cross-sectional study included 74 patients undergoing continuous hemodialysis. Serum samples were tested for IL-6 using an enzyme-linked immunosorbent assay. Mineral were analyzed using an electrolyte analyzer and biochemical tests. Parameter correlations were analyzed using the Pearson’s correlation test. Results: Among the studies group, the male: female ratio was 1:0.72. IL-6 mean value was 13.77 pg/ml ±9.79 SD. IL-6 was significantly negatively correlated with circulating iron and calcium levels (r= - 0.229, P= 0.049; r= -0.252, P= 0.03, respectively). IL-6 was significantly positively correlated with K+ levels (r= 0.269,P= 0.02). Conclusion: The present study highlighted the substantial role of IL-6 in mineral dysregulation in hemodialysis patients, highlighting this cytokine as a potential therapeutic target for minimizing and monitoring the clinical effects of mineral disturbances, including cardiovascular and neurological complications.

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First-year mortality in incident dialysis patients: results of the Peridialysis study

Cited by 2 publications

References 35 publications

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Mortality in elderly hemodialysis patients, influence of frailty and comorbidity

Serum Interleukin-6 is associated with hypocalcemia, hypoferritinemia and hyperkalemia in end-stage renal disease patients

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