Cardiovascular Mortality Burden High Among Young Adults With ESRD

Cardiovascular causes accounted for nearly 40% of deaths among study patients age 22 to 29 years at onset of treatment for kidney failure.

Young adults with end-stage renal disease (ESRD) have a higher rate of death and hospitalizations as a result of cardiovascular causes compared with children and adolescents, according to results of a new study published in JAMA Cardiology.

More than 33,100 patients age 1 to 29 years with ESRD were included in the study population. Patients were categorized by age at ESRD onset (1 to 11 years, 12 to 21 years, and 22 to 29 years or children, adolescents, and young adults, respectively). The researchers identified 4038 deaths in the young adult population. Of these deaths, 39% were related to cardiovascular disease, a team led by Zubin J. Modi, MD, from the Division of Pediatric Nephrology, Department of Pediatrics at the University of Michigan in Ann Arbor, reported in JAMA Cardiology.

Young adults had significantly higher cardiovascular mortality rates than adolescents and children, with adjusted cardiovascular mortality rates at 1, 3, and 5 years of 11, 37, and 70 deaths per 1000 patient-years, respectively, compared with 8, 29, and 65 deaths per 1000 patient-years for adolescents and 10, 22, and 42 deaths per 1000 patient-years for children.

Young adults also had significantly higher adjusted cardiovascular hospitalization rates than adolescents and children, with 1-, 3-, and 5-year rates of 138, 147, and 162 per 1000 patient-years, respectively, compared with 75, 102, and 116 per 1000 patient-years for adolescents and 48, 37, and 33 per 1000 patient-years for children.

Among patients with cystic, hereditary, and congenital conditions, young adults had a significant 55% and 78% higher risk for cardiovascular mortality compared with adolescents and children, respectively, in a fully adjusted model. Among those with glomerulonephritis, young adults had a significant 79% higher risk for cardiovascular mortality compared with children. The risk for young adults did not differ from that of adolescents, however.

Children and adolescents had a significant 59% and 14% lower risk for cardiovascular hospitalization than young adults.

Patients on hemodialysis and peritoneal dialysis had a 14-fold and 8.5-fold increased risk for cardiovascular hospitalization, respectively, and a 14-fold and 7.9-fold increased risk for cardiovascular mortality compared with those who received a preemptive kidney transplant.

Nephrology care prior to ESRD onset was associated with a significant 23% decreased risk for cardiovascular mortality, but was not associated with cardiovascular hospitalization risk.

“Young adults form a unique population that share features of both adult and pediatric ESRD, requiring specialized clinical and research attention to improve outcomes,” Dr Modi and colleagues concluded.

They also stated, “Potentially modifiable risk factors for this young adult population may include optimizing health care for the underlying kidney disease and other coexisting conditions before the onset of ESRD and increasing access to preemptive transplant.”

Reference

Modi ZJ, Lu Y, Ji N, et al. Risk of cardiovascular disease and mortality in young adults with end-stage renal disease [published online March 20, 2019]. JAMA Cardiol. doi:10.1001/jamacardio.2019.0375