Review Suggests Mortality Risk Factors for Patients on Dialysis

Older patients are at greater risk of death in the earliest stages of dialysis, while females possibly are at a higher risk than men, a review of studies found.

A systematic review of studies on dialysis patients found that older patients were at greater risk of death in the earliest stages of treatment, and that females possibly had a slightly higher risk than men.

The study, published recently in Clinical Medicine and Research, also investigated whether diabetics were at greater risk of early mortality but found the results do not support the conclusion.

Information has been scarce on risks faced by patients at the start of dialysis, a time that is particularly dangerous for those with advanced chronic kidney disease (CKD). The authors aimed the review at providing information to help patients make informed choices about their care.

Researchers from the United Kingdom searched studies from 1985-2017 involving adults beginning dialysis. The authors used 26 studies worldwide with a combined population of 1,098,769. A high risk of bias was found in half the studies. There were 17 cohort and 9 case-control studies.

Research has shown that up to 15%-20% of American adults suffer from CKD, with prevalence on the rise and the number needing dialysis growing. The risk of organ failure is high in the early days of dialysis because of the stress to the patient’s body. The treatment is associated with worsening heart function and accelerated loss of kidney function. Nutrition and inflammation also worsen as CKD advances. Mortality rates are highest in the initial weeks of dialysis before stabilizing at lower levels.

One study of 1000 patients found that those who died in the first 90 days were an average of 71 years old, while those who survived were an average of 61. Another found similar results and stated that for every 10-year increase in age, the hazard ratio (HR) of mortality increased by 1.50 (95% CI, 1.43-1.56). An additional study found that for each 5-year increase, the HR was 1.22 (95% CI, 1.21-1.23; P <.0001).

Introducing dialysis incrementally rather than at full doses has been proposed as a way to possibly reduce the risk of early mortality, the authors noted.

A majority of studies found no increased risk for males or females of early mortality, while others had mixed results, the authors said. However, when pooling high-quality studies that were amenable to extraction to form one large database of 453,587 patients, the early mortality rates were 31.9 (95% CI, 31.4-32.4) for women and 30.0 (95% CI, 29.7-30.4) for men per 100 person-years. Early mortality was considered death within 6 months of starting dialysis regardless of cause.

A database of 131,085 patients was similarly constructed to examine early death for patients with diabetes. The early mortality rates were 21.9 (95% CI, 21.1-22.6) for diabetics and 23.6 (95% CI, 23.1-24.2) for nondiabetics per 100 person-years. The results had shown diabetics to be at higher risk before excluding studies considered high risk for bias.

Reference

Hazara AM, Bhandr, SB. Age, gender and diabetes as risk factors for early deaths in dialysis patients. Clinical Med Res. Published online February 13, 2021. doi:10.3121/cmr.2020.1541