| Background and Objectives:Dialysis patients older than 65 years are increasing yearly because of an aging population,higher prevalence of metabolic diseases,and improvement of blood purification technology.The mortality rate of elderly maintenance hemodialysis patients is still high.Currently,there are still many acute and chronic complications in elderly patients with hemodialysis.The hospitalization rate of elderly maintenance hemodialysis patients is high and the quality of life is poor.The purpose of this study was to analyze the clinical features and risk factors associated with mortality of multi-center elderly maintenance hemodialysis patients.We conduct a meta-analysis about the risk factors associated with mortality of elderly maintenance hemodialysis patients and provide a basis for future prospective interventions,which might reduce the mortality and improve the prognosis of elderly maintenance hemodialysis patients.Methods:l.The elderly maintenance hemodialysis patients were retrospectively collected from the clinical information database of 15 army hospitalized patients from January 1,2009 to December 31,2011 using the special subject database of "Clinical Diagnosis and Treatment of Major Diseases in China".Peritoneal dialysis,kidney transplantation or dialysis patients with dialysis age less than 3 months were excluded.We analysed the detection rate,hospitalization reasons and clinical features,and laboratory data of the hospitalized elderly maintenance hemodialysis patients,in order to fully understand the clinical characteristics of hospitalized elderly hemodialysis patients.2.We selected 2738 elderly maintenance hemodialysis patients from the database.They were divided into death group and survival group to analyze the causes of death and logistic multivariate regression analysis was used to find mortality risk factors.3.The literature about the mortality risk factors in elderly maintenance hemodialysis patients was searched by the end of December 31,2017.A systematic review and meta-analysis were performed to identify the risk factors of mortality in elderly maintenance hemodialysis patients.Results:1.There were 621,457 hospitalized patients totally in the database,including 7135 maintenance hemodialysis patients,the detection rate was 1.15%.There were 308,982 elderly hospitalized patients,including 2738 elderly maintenance hemodialysis patients,the detection rate was 0.89%.There were 312475 younger hospitalized patients,including 4397 younger maintenance hemodialysis patients.The detection rate of younger maintenance hemodialysis was 1.41%.There was a statistically significant difference between the two detection rates(P<0.05).The average age of maintenance hemodialysis patients was 53.0 ± 17.8 years old,male patients accounted for 51.1%.The younger group included 3781 maintenance hemodialysis inpatients and 4397 hospitalizations.The average number of hospitalizations per patient was 1.18,of whom 3355 were hospitalized once,accounting for 88.7%,and 426 patients were hospitalized twice or more,accounting for 11.3%.The elderly group included 1487 maintenance hemodialysis patients and had a total of 2738 hospitalizations.The average number of patients was 1.85,of whom 991 patients were hospitalized once,accounting for 66.7%,and 496 patients were hospitalized twice or more,accounting for 33.3%.The rate of rehospitalization in elderly maintenance hemodialysis patients was high,and there was a statistically significant difference compared with the younger patients(P<0.001).The reason for hospitalization of elderly maintenance hemodialysis patients were as follows:infection(630 cases,23%),coronary heart disease(580 cases,21.2%),heart failure(274 cases,10%),electrolytes and acid-base disorders(178 cases,6.5%),cerebrovascular disease(144 cases,5.3%),dialysis access blocked or infected(127 cases,4.6%),and so on.The causes of the top three primary dialysis patients were diabetic nephropathy(1032 cases,37.7%),hypertensive renal injury(797 cases,29.1%),chronic glomerulonepritis(419 cases,15.3%).Central venous catheters accounted for 75.7%,67.5%and 27.9%in the elderly(?75 ys),non-elderly(60-74ys)and younger patients(<60ys)respectively.The eligibility rate of the hemodialysis quality control indicators as follows:hemoglobin were 27.5%,27.8%and 43.0%,albumin were 37%,45.6%and 56.9%,blood calcium were 45.7%,48.9%and 52.2%,and the blood phosphate were 12.4%,44.9%and 38.5%and blood PTH were 33.3%,38.5%and 58.8%in the elderly(?75 ys),non-elderly(60-74ys)and younger patients(<60ys)respectively.2.The mortality rate of elderly hospitalized maintenance hemodialysis patients was 9.01%while the mortality of younger hospitalized maintenance hemodialysis patients was 2.02%.There was a statistically significant difference(P<0.05).Among the elderly hospitalized maintenance hemodialysis patients,the top three causes of death were cardiovascular disease(46 cases,18.7%),infection(41 cases,16.7%)and cerebrovascular disease(33 cases,13.4%).Aging(OR = 1.59,95%CI:1.13-2.24),central venous catheter(OR = 1.62,95%CI:1.53-1.72)and CCI>3(OR=1.97,95%CI:1.49-2.60)were risk factors of death in elderly maintenance hemodialysis patients.High level of hemoglobin(OR=0.76,95%CI:0.73-0.79),albumin(OR=0.87,95%CI:0.77-0.98),uric acid(OR=0.90,95%CI:0.84-0.96)and those taking ACEI/ARB(OR=0.77,95%CI:0.58-0.90)had a lower risk of death.3.A meta-analysis of 14 eligible documents showed that age(OR=1.12,95%CI:1.10-1.14),combined CVD(OR=1.20,95%CI:1.00-1.44),DM(OR=1.19,95%CI:1.06-1.33),central venous catheter(OR=1.53,95%CI:1.44-1.62),early dialysis initiation(OR=1.18,95%CI:1.01-1.37),each 1g/dl decrease in albumin(OR=2.63,95%CI:1.19-5.81)and CCI>3(OR=1.41,95%CI:1.35-1.50)were risk factors of death in elderly maintenance hemodialysis patients.Patients with high level of hemoglobin(OR=0.88,95%CI:0.78-0.99)and BMI?25(OR=0.94,95%CI:0.92-0.96)were at lower risk of death.Conclusion:The detection rate of elderly hospitalized maintenance hemodialysis patients is lower while the rehospitalization rate is higher than the younger group.The main causes of hospitalization and death are infection,cardiovascular diseases,electrolytes and acid-base balance disorders and cerebrovascular diseases.Hemoglobin,albumin,blood calcium,phosphorus and blood PTH eligibility rates in elderly group were lower than the younger group.The incidence of hypophosphatemia and hypocalcemia were higher than the younger group.Age,CCI>3,low BMI,combined CVD,DM,anemia and malnutrition,the use of central venous catheters(CVC)and early initiation of dialysis are the major risk factors for mortality in elderly maintenance hemodialysis patients.Serum uric acid levels was negatively correlated to mortality of elderly maintenance hemodialysis patients,taking ACEI/ARB can reduce the mortality of elderly maintenance hemodialysis patients.Recognition of the risk factors of mortality in elderly maintenance hemodialysis patients can help to predict their prognosis and give effective interventions. |
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