How cardiovascular mortality has changed for patients on dialysis

A diagnosis of end-stage kidney disease means a drastically reduced life expectancy for a pediatric patient, and necessary dialysis can also have a negative impact on the patient’s mortality. A new study in JAMA Network Open provides information on whether the risk of death from cardiovascular disease has changed for the better in pediatric patients who initiated dialysis in the last 2 decades.¹

Investigators used a retrospective cohort study that examined the records of children and young adults who started dialysis between 1995 and 2015 using the United States Renal Data System database. They used Fine-Gray models to look at the trends in risk of different cardiovascular-related deaths. Models were also adjusted for sex, race, age, cause of end-stage kidney disease, insurance types, comorbidities, and neighborhood income. The investigators separated the children and young adults, participants aged 18 to 30 years, for analysis.

There were a total of 80,189 participants in the study who had started dialysis. In the median 14.3 (14.0-14.7) years of follow-up, 16,179 died. Among those who had died, 40.2%, 6505 of the 16,719 participants, were a result of cardiovascular-related causes. In the adjusted analysis, the risk of cardiovascular was stable in the earlier years, but it was found to be statistically significantly lower after 2006 among children who started dialysis (subhazard ratio [SHR], 0.74; 95% CI, 0.55-1.00), as well as in the adult group, which included young adults, (SHR, 0.90; 95% CI, 0.83-0.98). When comparing 2015 versus 1995, the risk of sudden cardiac death improved in all age groups, but it improved to a greater degree in children (SHR, 0.31; 95% CI, 0.20-0.47) than in young adults (SHR, 0.64; 95% CI, 0.56-0.73). Additionally, the risk of a stroke was statistically significantly lower starting in 2010 for children (SHR, 0.40; 95% CI, 0.18-0.88) as well as young adults (SHR, 0.76; 95% CI, 0.59-0.99).

The researchers concluded that the risk of a cardiovascular-related death went down for both children and young adults who initiated dialysis in the last 2 decades. However, the trends varied depending on the age when dialysis was started and the specific cause of death. They said that further studies were required to help improve the risk of cardiovascular disease in the pediatric population.

Reference

1. Ku E, McCulloch C, Ahearn P, Grimes B, Mitsnefes M. Trends in cardiovascular mortality among a cohort of children and young adults starting dialysis in 1995 to 2015. JAMA Netw Open. 2020;3(9):e2016197. doi:10.1001/jamanetworkopen.2020.16197