Abstract
The aim of this study was to evaluate the risk factors for cardiovascular hospitalization in hemodialysis patients. A cross-sectional cohort analysis of risk factors during one census month (November) and one-year follow-up for cardiovascular hospitalization rates during 5 consecutive years (2002-2006) in all end-stage renal disease patients hemodialyzed in Kaunas region was carried out. During the census month, we collected data on patient's age and sex, disability status, comorbidities, anemia control, malnutrition and inflammation, calcium-phosphorus metabolism, and patient's compliance with prescribed medications. We analyzed 559 patients during 1163 patient-years of observation. Patients were considered as new patients every year (1520 cases). Kaplan-Meier method and Cox regression analysis were used to evaluate time to first hospitalization. The mean number of cardiovascular hospitalizations was 0.31 per patient-year at risk, the total days of cardiovascular hospitalizations per patient-year at risk were 3.93, and the mean length of one hospitalization was 13.2±12.9 days. Cardiovascular diseases were the most frequent cause of hospitalization (25% of all hospitalizations). The relative risk of cardiovascular hospitalization increased by 1.03 for every year of age, by 1.7 for worse disability status, by 1.4 for nonadherence to medications, by 1.1 for every additional medication prescribed to the patient. Cardiovascular hospitalization risk was decreased by 0.99 with a 1-g/L rise in hemoglobin level. Older age, worse disability status, patient's noncompliance with medications, and higher number of medications used were associated with a higher risk for cardiovascular hospitalization. Higher hemoglobin level was associated with a lower risk for cardiovascular hospitalization.
Highlights
The world’s disease profile is changing, and chronic diseases account for majority of global morbidity and mortality
Worse disability status, patient’s noncompliance with medications, and higher number of medications used were associated with a higher risk for cardiovascular hospitalization
When testing patients’ comorbidities and disability status, the univariate analysis showed that worse disability status, older age, higher systolic blood pressure (BP) before HD, worse ejection fraction on ultrasound, worse NYHA functional status, and ischemic heart disease (IHD) were associated with more frequent cardiovascular hospitalizations
Summary
The world’s disease profile is changing, and chronic diseases account for majority of global morbidity and mortality. The causes of chronic kidney diseases reflect this change and diabetes, together with hypertension, is the major cause of end-stage renal disease (ESRD) [3]. This is a huge financial burden for society, and the treatment of ESRD accounts for a large part of it [3,4,5,6]. Cardiovascular diseases are one of the most common causes of hospitalization in hemodialysis patients [8,9,10,11,12]
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