Comorbidities and their impact on outcome in patients with end-stage renal disease

Abstract

Comorbidities and their impact on outcome in patients with end-stage renal disease. End-stage renal disease is associated with an increased mortality compared to age-matched controls. Increasing age, diabetes, cardiovascular disease and poor nutrition are the most important co-existing conditions that predict worse outcomes for patients with end-stage renal disease. Of the cardiovascular conditions that are associated with higher mortalities, ischemic heart disease and left ventricular hypertrophy have a high prevalence amongst the predialysis and dialysis population. There are multiple risk factors associated with uremia that predispose to these conditions. Congestive heart failure is also a strong predictor of poor outcome and often coexists with hypertension and ischemic heart disease. Although hypertension in the general population is associated with higher mortalities, in dialysis patients hypotension is a more accurate predictor of high mortality rates. Diabetes is now the most common cause of end-stage renal disease in many parts of the world. It has a strong negative impact on survival and is associated with the presence of vascular disease. Similarly, increasing age in the uremic population is associated with a high frequency of hypertension and vascular disease. Poor nutritional status, as indicated by a low serum albumin or subjective global assessment is a strong predictor of high mortality. This may in part indicate the coexistence of a chronic inflammatory state. The most important predictors of poor outcome in end-stage renal disease are increasing age, cardiovascular disease, diabetes and poor nutrition as reflected by hypoalbuminemia. Future studies need to be initiated which will assess the impact of interventions which modify directly these co-morbidities.