The risk of dying from cardiovascular disease (CVD) has been declining among children and young adults starting dialysis, according to a new study.

Elaine Ku, MD, MAS, of the University of California, San Francisco, and colleagues used the US Renal Data System to identify 80,189 patients younger than 30 years (median 24 years) who initiated dialysis from 1995 to 2015. During a median of 14.3 years of follow-up, 16,179 died. Of these, 6505 (40.2%) died from CVD-related causes.

In adjusted analyses, risk of CVD-related death was stable initially but became significantly lower after 2006 compared with 1995 among those starting dialysis either as children (26% decreased risk) or young adults (10% decreased risk), Dr Ku’s team reported in JAMA Network Open.

Dr Ku and her colleagues defined children as patients less than 18 years old and young adults as those aged 18 to 30 years.


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“To our knowledge, our study is among the first to compare and contrast temporal trends and cause-specific mortality risk in a cohort of children vs young adults starting dialysis.”

Comparing 2015 with 1995, the risk of sudden cardiac death (SCD) improved steadily in all age groups, but to a greater degree in children (69% decreased risk) compared with young adults (36% decreased risk). The risk of dying from a myocardial infarction (MI) was a significant 30% lower after 2005 compared with 1995 among young adults, but among children, the difference in risk of dying from an MI was not significantly different during most of the follow-up duration, according to the investigators.

The study population was 45.2% female, 36.8% Black, and 19.3% Hispanic White. The most common cause of end-stage kidney disease (ESKD) in the cohort was glomerulonephritis (37.4%).

Compared with the overall cohort, patients who died were older when they started dialysis (24.3 vs 22.5 years). They also were more likely to be female and Black and to have diabetes, and less likely to have glomerulonephritis as their cause of kidney failure.

“Given that CVD remains the most common cause of death in this population, strategies to further improve CVD risk profile in this young population are needed to enhance survival, and modification of nontraditional CV risk factors may be needed to ensure continued improvements in outcomes for young populations starting on dialysis.”

Although the study had a number of strengths, such as a large sample size, a large number of events, and inclusion of both children and young adults, it also had limitations. For example, the cause of death was missing from approximately 8% of patients, and misclassification of causes of death may have occurred, Dr Ku and her colleagues pointed out. They also acknowledged a lack of “more granular data that may be needed to determine exact reasons for changes in temporal trends in mortality over time, or changes in treatment of cardiovascular risk factors.

Disclosure: Several study authors declared affiliations with the pharmaceutical industry. Please see the original reference for a full list of authors’ disclosures.

Reference

Ku E, McCulloch CE, Ahearn P, et al. Trends in cardiovascular mortality among a cohort of children and young adults starting dialysis in 1995 to 2015. Published online September 1, 2020. JAMA Netw Open. doi:10.1001/jamanetworkopen.2020.16197