Nutritional status, cardiovascular comorbidities linked to increased mortality risk in older hemodialysis patients

In older hemodialysis patients, nutritional status and cardiovascular comorbidities appeared to be associated with mortality, and may serve as prognostic factors for poor survival, according to findings published in Nephrology Dialysis Transplantation.

“The prognostic impact of several complications of chronic kidney disease, such as protein-energy wasting, anemia, hypertension, and mineral and bone disorder has already been evaluated in this population,” Cédric Villain, MD, of the service de neprhologie, Hopital Amboise Paré, Boulogne-Billancourt, France, and colleagues wrote in the study’s introduction. “However, their relative weights on risk of death have not yet been studied. Because all comorbidities cannot always be treated at the same time, geriatric patients frequently need prioritization in care. Physicians thus need to distinguish between what should be treated and monitored first and what should be treated later.”
used data on 3,165 incident hemodialysis patients aged 75 years and older (average age, 81.9 years) involved in the French Phosphorus and Calcium Observatory, a large European prospective study evaluating calcium and phosphorus disorders in hemodialysis patients. Using an electronic report system, the researchers collected data from 178 participating dialysis units.
used data from the third phase of the study, beginning on October 2010 and ending in October 2015. They collected individual data every 6 months. Baseline data included patient demographics, comorbidities, and dialysis treatment acquired at study entry. The researchers prospectively gathered clinical variables, laboratory results, and drugs prescribed.

The researchers used structural equation models to calculate the following: nutritional status, anemia, mineral and bone disorders, and cardiovascular comorbidities. Systolic blood pressure was used for survival analysis, because it was considered more relevant in predicting mortality vs. diastolic blood pressure.

Poisson models were used to conduct survival analyses.

The median follow-up was 1.51 years, and 35.5% of the patients died. Univariate analysis revealed a significant association between mortality and all assessed variables. In multivariate analysis, nutritional status was most strongly correlated with mortality. Each standard deviation (SD) decrement in nutritional status value was correlated with a 42% increase in mortality risk (incidence rate ratio [IRR] 1.42; 95% CI, 1.32-1.53). Each SD increase in chronic kidney disease-mineral and bone disorder was linked to a 14% increase in mortality risk (IRR: 1.14; 95% CI, 1.06-1.23). With each SD increase in the normalized systolic blood pressure value, there was a decrease in mortality risk (IRR: 0.86; 95%CI, 0.8-0.93).

A trend was also observed regarding poor survival in individuals with low intact parathyroid hormone or high serum calcium.

“Given the prime importance of optimal nutritional status for the survival of elderly hemodialysis patients, every attempt seems justified to prevent the occurrence of protein-energy wasting,” the researchers wrote. “Concerning the association observed between the other CKD complications and mortality risk, it would be wise to avoid iatrogenic hypertension and also low serum phosphorus and iPTH, as well as high serum calcium levels, by appropriate therapeutic measures.”

Disclosure: Villain reports receiving an educational grant from Sanofi to perform

the statistical analysis. Please see the full study for all other authors’ relevant disclosures.