Abstract
BackgroundStudies on risk factors of mortality in elderly patients with hemodialysis usually focus on comorbidities, nutrition, and inflammation. Discussion on the correlation between living environment and mortality of these patients is limited.MethodsA total of 256 elderly hemodialysis patients participated in this 2-year prospective observational study. The subjects were divided into 2 subgroups based on whether they were living in Taipei Basin (n = 63) or not (n = 193). Demographic, hematological, nutritional, inflammatory, biochemical, and dialysis-related data were obtained for cross-sectional analysis. Causes of death and mortality rates were also analyzed for each subgroup.ResultsPatients in the basin group had a higher incidence of combined protein-energy wasting and inflammation than those in the around basin group. At the end of the 2-year follow-up, 68 patients had died. Univariate binary logistic regression analysis revealed that a very advanced age, basin group, serum albumin levels, serum creatinine levels, non-anuria, and the complications of stroke and CAD were associated with 2-year mortality. Meanwhile, log high-sensitivity C-reactive protein (hs-CRP) levels were not associated with 2-year mortality. Multivariate Cox regression analysis revealed that basin group, serum albumin levels, and the complications of stroke and CAD were significant risk factors for 2-year mortality in these patients.ConclusionThe results of this study indicate that factors such as living in the Taipei Basin with higher air pollutant levels in elderly hemodialysis patients is associated with protein-energy wasting and inflammation, as well as 2-year mortality. These findings suggest that among this population, living environment is as important as comorbidities and nutrition. Furthermore, air pollution should be getting more attention especially in the overcrowding Basin topography.
Highlights
The prevalence of dialysis in elderly patients is increasing worldwide [1], owing to advanced health insurance [2] and better management of comorbidities and chronic diseases such as diabetes mellitus (DM), cardiovascular disease, cerebral vascular disease, and malignancy
In a study on short-term survival of elderly patients on dialysis, increased alcohol consumption, cardiac dyskinesis, age at onset of dialysis, serum phosphate, and number of comorbid illnesses were correlated with the risk of mortality and normal serum albumin reduced the risk of mortality [7]
Written informed consent was obtained from every participating subject, and the study was approved by the institutional review board of the Chang Gung Memorial Hospital
Summary
The prevalence of dialysis in elderly patients is increasing worldwide [1], owing to advanced health insurance [2] and better management of comorbidities and chronic diseases such as diabetes mellitus (DM), cardiovascular disease, cerebral vascular disease, and malignancy. Functional dependence, impaired intellectual status, diabetes, low serum albumin, peripheral vascular disease, and late referral for ESRD treatment are poor prognostic factors in this population [5]. In patients with these comorbidities, and especially in those with coronary heart disease, dialysis might not offer a survival advantage [8,9]. To the best of our knowledge, studies on elderly hemodialysis (HD) patients mostly focus on nutrition and comorbidities, and study on living environment is limited. Discussion on the correlation between living environment and mortality of these patients is limited
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