Kidney & blood pressure research · 2025
Mortality of Patients with Heart Diseases and Unplanned Start of Maintenance Hemodialysis in the City of São Paulo, Brazil.
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Samaan Farid, Minuzzo Luiz, Loca Amanda Paz, Dias Amanda Souza, Monteiro Isabel Longo Oliveira, Campos Gonçalves Karla Lorena, Rochel Larissa Moreira, Melhim Lina Ahamad, Paduam Veronica, Ottoni Oliveira Vitoria Falotico, Souza Costa Yara Lopes, Damiani Lucas Petri, Franchini Kleber Gomes, Feres Fausto, Mastroianni Kirsztajn Gianna, Sesso Ricardo
Аннотация
INTRODUCTION: Chronic kidney disease worsens the prognosis of cardiovascular disease (CVD) and vice versa. This study aimed to evaluate the mortality of patients with a high CVD burden and unplanned start of maintenance hemodialysis (HD).
METHODS: A retrospective study was performed at a tertiary cardiological hospital in São Paulo, Brazil. Hospitalized patients ≥18 years old were identified by the public chronic kidney replacement therapy regulatory system between January 1, 2014, and December 31, 2018. In-hospital and post-discharge mortality, along with associated risk factors, were assessed. Death information up to December 31, 2022, was obtained from the state of São Paulo mortality database.
RESULTS: A total of 302 patients with unplanned start of HD were included. The mean age was 65 ± 13 years old; 68% were male. The heart conditions were as follows: 60% chronic heart failure, 27% coronary artery disease, 13% arrhythmia, and 7% valve disease. Comorbidities included: 93% hypertension, 62% diabetes, 31% dyslipidemia, and 27% known CKD. The mortality rate (deaths per 100 patient-years) was 71.4 between 0 and 3 months, 23.0 between 3 and 12 months, and 39.5 over the entire 0 to 12 months period. The factors independently associated with in-hospital death were age, heart valve disease, chronic obstructive pulmonary disease, positive serology for hepatitis B, and need for HD catheter replacement. The factors associated with post-discharge death (mean ± SD follow-up: 6.4 ± 1.4 years) were age, presence of two or more heart diseases, and HD catheter-related infection.
CONCLUSION: Patients with a high burden of cardiovascular morbidity and an unplanned start of HD exhibit elevated mortality rates. Some factors independently related to poorer outcomes, such as HD catheter-related complications, could potentially be mitigated through adequate pre-dialysis care.
METHODS: A retrospective study was performed at a tertiary cardiological hospital in São Paulo, Brazil. Hospitalized patients ≥18 years old were identified by the public chronic kidney replacement therapy regulatory system between January 1, 2014, and December 31, 2018. In-hospital and post-discharge mortality, along with associated risk factors, were assessed. Death information up to December 31, 2022, was obtained from the state of São Paulo mortality database.
RESULTS: A total of 302 patients with unplanned start of HD were included. The mean age was 65 ± 13 years old; 68% were male. The heart conditions were as follows: 60% chronic heart failure, 27% coronary artery disease, 13% arrhythmia, and 7% valve disease. Comorbidities included: 93% hypertension, 62% diabetes, 31% dyslipidemia, and 27% known CKD. The mortality rate (deaths per 100 patient-years) was 71.4 between 0 and 3 months, 23.0 between 3 and 12 months, and 39.5 over the entire 0 to 12 months period. The factors independently associated with in-hospital death were age, heart valve disease, chronic obstructive pulmonary disease, positive serology for hepatitis B, and need for HD catheter replacement. The factors associated with post-discharge death (mean ± SD follow-up: 6.4 ± 1.4 years) were age, presence of two or more heart diseases, and HD catheter-related infection.
CONCLUSION: Patients with a high burden of cardiovascular morbidity and an unplanned start of HD exhibit elevated mortality rates. Some factors independently related to poorer outcomes, such as HD catheter-related complications, could potentially be mitigated through adequate pre-dialysis care.