Importance of Dialysis Specialists in Early Mortality in Elderly Hemodialysis Patients: a Multicenter Retrospective Cohort Study

Overview

Journal Sci Rep

Specialty Science

Date 2024 Jan 22

PMID 38253679

Authors

Yohan Park

Ji Won Lee

Se-Hee Yoon

Sung-Ro Yun

Hyunsuk Kim

Eunjin Bae

Young Youl Hyun

Sungjin Chung

Soon Hyo Kwon

Jang-Hee Cho

Kyung Don Yoo

Woo Yeong Park

In O Sun

Byung Chul Yu

Gang-Jee Ko

Jae Won Yang

Sang Heon Song

Sung Joon Shin

Yu Ah Hong

Won Min Hwang

Affiliations

Soon will be listed here.

Abstract

The early mortality rate in elderly patients undergoing hemodialysis is more than twice that in young patients, requiring more specialized healthcare. We investigated whether the number of professional dialysis specialists affected early mortality in elderly patients undergoing hemodialysis. This multicenter retrospective cohort study analyzed data from 1860 patients aged ≥ 70 years who started hemodialysis between January 2010 and December 2017. Study regions included Seoul, Gyeonggi-do, Gangwon-do, Daejeon/Chungcheong-do, Daegu/Gyeongsangbuk-do, and Busan/Ulsan/Gyeongsangnam-do. The number of patients undergoing hemodialysis per dialysis specialist was calculated using registered data from each hemodialysis center. Early mortality was defined as death within 6 months of hemodialysis initiation. Gangwon-do (28.3%) and Seoul (14.5%) showed the highest and lowest early mortality rate, respectively. Similarly, Gangwon-do (64.6) and Seoul (43.9) had the highest and lowest number of patients per dialysis specialist, respectively. Relatively consistent results were observed for the regional rankings of early mortality rate and number of patients per dialysis specialist. Multivariate Cox regression analysis-adjusted for previously known significant risk factors-revealed that the number of patients per dialysis specialist was an independent risk factor for early mortality (hazard ratio: 1.031, p < 0.001). This study underscores the growing need for dialysis specialists for elderly hemodialysis patients in Korea.

References

Kim K, Kim O . Super Aging in South Korea Unstoppable but Mitigatable: A Sub-National Scale Population Projection for Best Policy Planning. Spat Demogr. 2021; 8(2):155-173. PMC: 8248505. DOI: 10.1007/s40980-020-00061-8. View

Park J, Lee Y, Kim K, Kim D . Korean Society of Nephrology hemodialysis unit accreditation report (2016-2020) and future directions. Kidney Res Clin Pract. 2022; 41(2):165-174. PMC: 8995479. DOI: 10.23876/j.krcp.21.151. View

Kim Y, Yoo K, Kim H, Koh J, Yu Y, Kwon Y . Association of serum mineral parameters with mortality in hemodialysis patients: Data from the Korean end-stage renal disease registry. Kidney Res Clin Pract. 2018; 37(3):266-276. PMC: 6147195. DOI: 10.23876/j.krcp.2018.37.3.266. View

Wick J, Turin T, Faris P, MacRae J, Weaver R, Tonelli M . A Clinical Risk Prediction Tool for 6-Month Mortality After Dialysis Initiation Among Older Adults. Am J Kidney Dis. 2016; 69(5):568-575. DOI: 10.1053/j.ajkd.2016.08.035. View

Jin D, Yun S, Lee S, Han S, Kim W, Park J . Current characteristics of dialysis therapy in Korea: 2015 registry data focusing on elderly patients. Kidney Res Clin Pract. 2016; 35(4):204-211. PMC: 5142391. DOI: 10.1016/j.krcp.2016.09.006. View

Canaud B, Tong L, Tentori F, Akiba T, Karaboyas A, Gillespie B . Clinical practices and outcomes in elderly hemodialysis patients: results from the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2011; 6(7):1651-62. PMC: 4204107. DOI: 10.2215/CJN.03530410. View

Lee Y, Kim K, Kim D . Current status and standards for establishment of hemodialysis units in Korea. Korean J Intern Med. 2013; 28(3):274-84. PMC: 3654122. DOI: 10.3904/kjim.2013.28.3.274. View

Bradbury B, Fissell R, Albert J, Anthony M, Critchlow C, Pisoni R . Predictors of early mortality among incident US hemodialysis patients in the Dialysis Outcomes and Practice Patterns Study (DOPPS). Clin J Am Soc Nephrol. 2007; 2(1):89-99. DOI: 10.2215/CJN.01170905. View

Park H, Choi H, Kim D, Cho A, Kwon Y, Ryu D . Hemodialysis facility star rating affects mortality in chronic hemodialysis patients: a longitudinal observational cohort study. Kidney Res Clin Pract. 2022; 42(1):109-116. PMC: 9902734. DOI: 10.23876/j.krcp.22.039. View

10.

Couchoud C, Beuscart J, Aldigier J, Brunet P, Moranne O . Development of a risk stratification algorithm to improve patient-centered care and decision making for incident elderly patients with end-stage renal disease. Kidney Int. 2015; 88(5):1178-86. DOI: 10.1038/ki.2015.245. View

11.

Couchoud C, Labeeuw M, Moranne O, Allot V, Esnault V, Frimat L . A clinical score to predict 6-month prognosis in elderly patients starting dialysis for end-stage renal disease. Nephrol Dial Transplant. 2008; 24(5):1553-61. PMC: 3094349. DOI: 10.1093/ndt/gfn698. View

12.

. KDIGO 2017 Clinical Practice Guideline Update for the Diagnosis, Evaluation, Prevention, and Treatment of Chronic Kidney Disease-Mineral and Bone Disorder (CKD-MBD). Kidney Int Suppl (2011). 2019; 7(1):1-59. PMC: 6340919. DOI: 10.1016/j.kisu.2017.04.001. View

13.

Soler M, Montero N, Pascual M, Barrios C, Marquez E, Orfila M . Age may explain the association of an early dialysis initiation with poor survival. QJM. 2014; 107(11):879-86. DOI: 10.1093/qjmed/hcu105. View

14.

Anand S, Kurella Tamura M, Chertow G . The elderly patients on hemodialysis. Minerva Urol Nefrol. 2010; 62(1):87-101. PMC: 4108205. View

15.

Lukowsky L, Kheifets L, Arah O, Nissenson A, Kalantar-Zadeh K . Patterns and predictors of early mortality in incident hemodialysis patients: new insights. Am J Nephrol. 2012; 35(6):548-58. PMC: 4587354. DOI: 10.1159/000338673. View

16.

Fukuma S, Ikenoue T, Akizawa T, Fukuhara S . Impact of nutritional index on the association between phosphorus concentrations and mortality in haemodialysis patients: a cohort study from dialysis outcomes and practice pattern study in Japan. BMJ Open. 2017; 7(8):e016682. PMC: 5629681. DOI: 10.1136/bmjopen-2017-016682. View

17.

Naveed H, Tirumandyam G, Krishna Mohan G, Gul S, Ali S, Siddiqui A . Effect of Discontinuation of Renin Angiotensin-System Inhibitors in Patients With Advanced Chronic Kidney Disease: A Meta-Analysis. Cureus. 2023; 15(4):e37813. PMC: 10197020. DOI: 10.7759/cureus.37813. View

18.

Berger J, Jaikaransingh V, Hedayati S . End-Stage Kidney Disease in the Elderly: Approach to Dialysis Initiation, Choosing Modality, and Predicting Outcomes. Adv Chronic Kidney Dis. 2015; 23(1):36-43. DOI: 10.1053/j.ackd.2015.08.005. View

19.

Canaud B, Ye X, Usvyat L, Kooman J, van der Sande F, Raimann J . Clinical and predictive value of simplified creatinine index used as muscle mass surrogate in end-stage kidney disease haemodialysis patients-results from the international MONitoring Dialysis Outcome initiative. Nephrol Dial Transplant. 2020; 35(12):2161-2171. PMC: 7716813. DOI: 10.1093/ndt/gfaa098. View

20.

Saeed F, Arrigain S, Schold J, Nally Jr J, Navaneethan S . What are the Risk Factors for One-Year Mortality in Older Patients with Chronic Kidney Disease? An Analysis of the Cleveland Clinic CKD Registry. Nephron. 2018; 141(2):98-104. DOI: 10.1159/000494298. View