Abstract
Introduction: The prevalence of chronic kidney disease (CKD) and heart failure (HF) has been rising over the past decade, with a prevalence close to 40%. Cardiovascular disease and malnutrition are common comorbidities and known risk factors for mortality in haemodialysis (HD) patients. We aimed to evaluate the one-year mortality rate after dialysis induction, and the impact of serum albumin levels on survival outcomes, in patients with CKD and HF. Methods: This was a retrospective analysis of patients with CKD and HF who underwent chronic HD between January 2016 and December 2019 in a tertiary-care Portuguese hospital. Variables were submitted to univariate and multivariate analysis to determine factors predictive of one-mortality after HD start. Results: In total, 204 patients were analysed (mean age 75.1 ± 10.3 years). Within the first year of HD start, 28.7% of patients died. These patients were significantly older [79.8 ± 7.2 versus 72.9 ± 10.9 years, p < 0.001; OR 1.08 (1.04–1.13), p < 0.001] and had a higher mean Charlson Index [9.0 ± 1.8 versus 8.3 ± 2.0, p = 0.015; OR 1.22 (1.04–1.44), p = 0.017], lower serum creatinine [5.1 ± 1.6 mg/dL versus 5.8 ± 2.0 mg/dL; p = 0.021; OR 0.80 (0.65–0.97), p = 0.022], lower albumin levels [3.1 ± 0.6 g/dL versus 3.4 ± 0.6 g/dL, p < 0.001; OR 0.38 (0.22–0.66), p = 0.001] and started haemodialysis with a central venous catheter more frequently [80.4% versus 66.2%, p = 0.050]. Multivariate analysis identified older age [aOR 1.07 (1.03–1.12), p = 0.002], lower serum creatinine [aOR 0.80 (0.64–0.99), p = 0.049] and lower serum albumin [aOR 0.41 (0.22–0.75), p = 0.004] as predictors of one-year mortality. Conclusion: In our cohort, older age, lower serum creatinine and lower serum albumin were independent risk factors for one-year mortality, highlighting the prognostic importance of malnutrition in patients starting chronic HD.
Highlights
The prevalence of chronic kidney disease (CKD) and heart failure (HF)has been rising over the past decade, with a prevalence close to 40%
We aimed to evaluate the one-year mortality rate after dialysis induction and the impact of serum albumin levels on outcomes in patients with chronic kidney disease (CKD) and heart failure (HF)
In our cohort of HF patients who initiated chronic HD, one-year mortality was highest in older patients (79.8 ± 7.2 versus 72.9 ± 10.9 years, p < 0.001; adjusted odds ratio (aOR) 1.07 (1.03–1.12), p = 0.002), as well as in patients with lower serum albumin levels
Summary
The prevalence of chronic kidney disease (CKD) and heart failure (HF)has been rising over the past decade, with a prevalence close to 40%. The prevalence of chronic kidney disease (CKD) and heart failure (HF). Cardiovascular disease and malnutrition are common comorbidities and known risk factors for mortality in haemodialysis (HD). We aimed to evaluate the one-year mortality rate after dialysis induction, and the impact of serum albumin levels on survival outcomes, in patients with CKD and HF. Methods: This was a retrospective analysis of patients with CKD and HF who underwent chronic HD between January. Within the first year of HD start, 28.7% of patients died. Chronic kidney disease (CKD), mainly end-stage renal disease (ESRD), is recognised as a serious risk factor for mortality. HD is the major treatment modality for renal replacement therapy worldwide and has the highest mortality rate, with 40% of patients surviving for five years in a large prospective United States-based study. Mortality is 10–20 times higher than in the general population, and annual mortality is around 9% per year [2,3]
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