| ObjectiveThis study was conducted to identify the demographic features,mortality,and causes of death in older adults with end-stage kidney disease(ESRD)receiving urgent-start peritoneal dialysis(USPD),and to investigate the risk factors for mortality within and after 6 months of USPD in this population to provide a basis for improving survival rates.MethodsThe clinical data of 379 elderly USPD patients between January 1,2013,and December 31,2019,who were treated with USPD and met the inclusion requirements at the Second Hospital of Jilin University,the Second Department of the First Hospital of Jilin University,the Jilin Provincial Central Hospital,the Jilin First Automobile Work General Hospital and the Xing’anmeng People’s Hospital were retrospectively analyzed,including demographic data,primary disease,comorbidities,and pre-dialysis laboratory indices.These enrolled patients were followed up until June 30,2020,regressions were recorded,especially the time and cause of death.In terms of different time-point of death occurrence,patients were separated into two groups: those who died within 6 months and those who died after 6 months,and the baseline data were compared with the patients in the survival group of the corresponding period,respectively.The mortality of patients within different periods was analyzed,and the Kaplan-Meier survival function was used to compare the survival of patients with different New York Heart Association(NYHA)cardiac function classifications.The risk factors related to patient death within and after 6months were analyzed by applying multivariate COX proportional-hazard models Results1.The mean age of the patients eventually included in this study was(71.95 ±5.75)years.45 patients died in the first 6 months after tube placement,with a mean age of(73.33 ± 5.95)years.patients who died in the first 6 months had worse cardiac function,higher white blood cell(WBC)levels,and lower serum albumin levels compared to survival patients(P < 0.05).85 patients with a mean age of(72.31 ± 6.25)years died after 6 months.The WBC,serum creatinine,potassium,and phosphorus levels were lower in patients who died compared to those who survived(P < 0.05).2.The median follow-up time was 30 months,and a total of 130 patients died during the entire follow-up period.The 1,3,and 6-month,and 1,2,and 3-year survival rates were 93.7%,91.8%,88.3%,84.3%,72.7%,and 66.0%.The most deaths occurred in the first 6 months,especially in the first month,and the most frequent cause of death was cardiovascular disease,both in the first 6 months and after 6months.3.Within the first 6 months of USPD treatment,survival was worse in patients with class III-IV cardiac function compared with those with normal cardiac function(P < 0.25);after 6 months,there was no statistically significant difference between patients with class III-IV cardiac function and those with normal cardiac function in terms of survival.(P > 0.25).The results of the multivariable COX regression analysis suggested that the risk factors for patient death within 6 months were NYHA class III-IV [hazard ratio(HR)= 2.457,95% confidence interval(CI):1.200-5.030,P =0.014)] and baseline higher WBC levels(HR=1.082,95%CI:1.021-1.147,P = 0.008).Cardiac function class III-IV(HR = 1.965,95% CI: 1.167-3.307,P = 0.011),baseline lower WBC levels(HR = 0.915,95% CI: 0.841-0.995,P = 0.038),lower potassium levels(HR = 0.580,95% CI: 0.424-0.793,P = 0.001)and higher calcium levels(HR =2.181,95% CI: 1.030-4.618,P = 0.042)were significant risk factors for mortality after 6 months.ConclusionMore attention needs to be paid to the first 6 months of USPD treatment in elderly patients with ESRD,and the population requires extra vigilance in terms of the risk of cardiovascular death.In short,we identified different risk factors associated with the first 6 months and after 6-month mortality in elderly USPD patients,and interventions on these risk factors including cardiac function,WBC,potassium,and calcium before and after USPD treatment are needed to improve patient survival. |
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