Hypertension, Diabetes at Hemodialysis Initiation Increasing
From 1995 to 2015, the prevalence of hypertension and diabetes among patients starting hemodialysis increased from 67.9% to 87.6% and from 43.1% to 59.6%, respectively.
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NEW ORLEANS—Patients with end-stage renal disease are starting hemodialysis (HD) at increasingly older ages and with more diabetes and hypertension, according to a study of 20-year data presented at the American Society of Nephrology's Kidney Week 2017 meeting. Nevertheless, they are living longer and are experiencing a decline in peripheral vascular disease (PVD) and stroke. The prevalence of cardiovascular disease has remained flat.
The study, which used data from the U.S. Renal Data System (USRDS), included 1,864,386 patients who initiated HD from 1996 to 2015. A team led jointly by Rita McGill, MD, MS, of the University of Chicago, and Jennifer Bragg-Gresham, MS, PhD, from the USRDS Coordinating Center at the University of Michigan, found that the mean age of HD patients at dialysis initiation increased from 61.5 years in 1996 to 63.8 years in 2015. From 1995 to 2015, the prevalence of hypertension and diabetes at HD initiation increased from 67.9% to 87.6 % and from 43.1% to 59.6%, respectively. During that same period, the prevalence of PVD and stroke decreased from 14.6% to 10.9% and from 9.2% to 8.8%, respectively.
In adjusted analyses, each successive 5-year period was associated with a significant 34% and 16% higher odds of hypertension and diabetes, respectively, and a 9% and 2% lower odds of PVD and stroke, respectively. The log hazard of first-year mortality decreased during this period, “suggesting improving health status of incident HD patients over time, which also may be related to decreasing first-year mortality rates,” the authors noted.
“The really exciting thing is that even though patients initiating hemodialysis have more and more traditional cardiovascular risk factors, their atherosclerosis outcomes are improving – which suggests that care may be improving,” Dr McGill told Renal & Urology News.
“While a trend toward a lower first-year mortality rate has been observed from 2010 to 2014, recent leveling off of this effect suggests there is no room for complacency, and continued efforts are needed to further improve patient outcomes,” Dr Bragg-Gresham said.
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McGill RL, Bragg-Gresham J, He K, et al. Long-term trends in the co-morbid disease burden of incident hemodialysis patients. Presented in poster format at Kidney Week 2017 in New Orleans (Oct. 31 to Nov. 5). Poster FR-PO858.