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

Abstract

Background Elderly Hemodialysis patients are increasing yearly. Antihypertensive medications are commonly prescribed to hemodialysis patients but the optimal regimens to prevent morbidity andmortality are unknown. The goal of our study was to compare the association of routinely prescribed antihypertensive regimens with outcomes and analyze the risk factors in elderly hemodialysis patients.Methods This study was a retrospective cohort study based on data from adult hemodialysis patients (≥18 years old) admitted to 15 hospitals in China between 1 January 2009 and 31 December 2011. The characteristics of elderly hemodialysis patients (≥60 years old) were analyzed. Antihypertensive drugs into the following regimens: β-blockers, calcium channel blockers, renin–angiotensin system (RAS) blocking drugs and α-blockers. Logistic regression analysis was used to explore the risk factors for death adjusting for clinical and laboratory values and antihypertensive medications.Results A total of 7135 patients on maintenance hemodialysis including 2738 elderly patients were enrolled in this study. The mean levels of hemoglobin, albumin, blood calcium, phosphorus and parathyroid hormone (PTH) in elderly group were lower than the younger group. We compared the characteristics of 2492 survived elderly maintenance hemodialysis patients and 246 patients who died.Aging (OR = 1.59, 95% CI: 1.13-2.24), central venous catheter (OR = 1.62, 95% CI: 1.53-1.72) and Charlson comorbidities index>3(OR=1.97,95% CI: 1.49-2.60)were independently risk factors of mortality in elderly maintenance hemodialysis patients. High levels of hemoglobin (OR=0.76, 95%CI: 0.73-0.79), albumin (OR=0.87, 95%CI: 0.77-0.98), uric acid(OR=0.90,95%CI: 0.84-0.96)and those taking angiotensin-converting enzyme inhibitor (ACEI) or an angiotensin II receptor blocker (ARB) (OR=0.77, 95%CI: 0.58-0.90) had a lower risk of mortality.Conclusions Age, Charlson Comorbidities index >3, anemia and malnutrition, the use of central venous catheters and low serum uric acid level are risk factors for mortality in elderly maintenance hemodialysis patients. Taking ACEI/ARB can reduce the mortality of elderly maintenance hemodialysis patients.