CVD in Young Adults with ESRD Causes Higher Hospitalization, Mortality Rates

A new study has found that cardiovascular disease (CVD) in young adults with end-stage renal disease (ESRD) may be more dangerous than previously known.

After examining more than 33,000 patients, the study found that cardiovascular disease accounted for almost 40% of death in young adults with incident ESRD, which was higher than the number found among adolescents and children.

Investigators examined 33,156 patients from the US Renal Data System, aged between 1 and 29 years, during a time period that lasted from January 1, 2003 until December 31, 2013. The goal of the study was to determine if young adult-onset ESRD is associated with higher cardiovascular (CV) hospitalizations and mortality rates than childhood-onset ESRD. The study also included data available from the Centers for Medicaid and Medicare Services Medical Evidence Form.

Investigators used data from the US Renal Data System to categorize patients who initiated ESRD care between the aforementioned dates by their age at onset. Those 3 groups were patients aged 1 to 11 years (children), 12 to 21 years (adolescents), and 22 to 29 years (young adults). Analysis of this data occurred between May 2016 and December 2016. Patients who died from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014 were censored. Of the study population, 5357 (16.2%) died, 1195 (3.6%) were lost to follow-up, 2247 (6.8%) recovered, and 24357 (73.4%) survived to the end of the study period.

Investigators found that young adults, between 22 and 29 years, had a 1-year CV hospitalization rate of 138 per 1000 years. This proved to be a higher risk of CV hospitalization than children and adolescents. Of 4038 young adult deaths, 1577 (39.1%) were due to cardiovascular disease. The five-year cumulative incidence of mortality in this group was 7.3% was higher than in younger patients, which was 4% in adolescents and 1.7% in children.

Adolescents had a lower risk for CV mortality than young adults for all causes of ESRD except glomerulonephritis. Higher risks for CV hospitalization and mortality were associated with lack of preemptive transplant compared with hemodialysis. In addition to this, investigators found that nephrology care before ESRD was associated with lower risk for CV mortality.

Investigators determined young adults had significantly higher, with higher 1-year, 3-year, and 5-year CVD hospitalizations rates and a higher 5-year CVD mortality probability than younger age groups with ESRD. Based upon the results of the study, young adults with incident ESRD had a 143 to 500 times higher risk for CVD mortality than the age-matched general population. The study also highlighted the profound impact of CVD, with 37.7% of total deaths attributed to CVD causes in patients with ESRD who had started renal replacement therapy between age 1 and 29 years.

Authors noted that there were multiple limitations of this study. The study did not include patients with ESRD onset before the age of 1 year or after the age of 29. The study was also limited by lack of access to data on the use of anti-hypertensive or lipid-lowering medications and detailed information regarding pre-ESRD management.

This study, "Risk of Cardiovascular Disease and Mortality in Young Adults With End-stage Renal Disease An Analysis of the US Renal Data System," was published in Journal of the American Medical Association.