Young Adults with Renal Disease Incur a Higher Risk of Developing Heart Disease than Children and Adolescents

Young adults with end-stage renal disease (ESRD) incur a higher risk of developing cardiovascular disease (CVD) than children and adolescents with ESRD, according to a study published in JAMA Cardiology.

In this population-based cohort study, researchers used the US Renal Data System to designate 33,156 patients who started ERSD care between 2003 and 2013 by age at ESRD onset (1-11, 12-21, and 22-29 years). They identified cardiovascular hospitalizations using discharge codes from the International Classification of Diseases, Ninth Revision, and CV mortality from the Centers for Medicare & Medicaid ESRD Death Notification Form. They then censored patients at death from non-CVD events, loss to follow-up, recovery, or survival to December 31, 2014. Moreover, adjusted proportional hazard models (95% CI) were fit to establish risk of CV hospitalizations and mortality by age group. The researchers conducted the data analysis between May 2016 and December 2017.

Increased Mortality Rate

The study’s findings suggest that young adults (aged 22-29 years) had a 1-year CV hospitalization rate of 138 (95% CI, 121 to 159) per 1,000 patient-years. Young adults had a higher risk for CV hospitalization than children (aged 1-11 years; HR=0.41; 95% CI, 0.26 to 0.64), and adolescents (aged 12-21 years; HR= 0.86; 95% CI, 0.77 to 0.97). Moreover, of 4,038 recorded deaths in young adults, 1,577 (39.1%) were attributed to CVD. The five-year cumulative incidence of mortality in this group (7.3%) was higher than in younger patients (adolescents, 4.0%; children, 1.7%). Adjusted HRs for CV mortality were higher for young adults with all causes of ESRD juxtaposed to children (cystic, hereditary, congenital conditions: (HR=0.22; 95% CI, 0.11 to 0.46), glomerulonephritis: (HR=0.21; 95% CI, 0.10 to 0.44), and other conditions: (HR=0.33; 95% CI, 0.23 to 0.49).

Young adults with incident ESRD have different cardiovascular risk factors, suggesting need for age-specific strategies @zjmodi #VisualAbstract pic.twitter.com/IGUWPVL52F

— CHEAR (@UMchear) March 20, 2019

Furthermore, the results indicate that adolescents had a lower risk for CV mortality than young adults for all causes of ESRD except glomerulonephritis (cystic, hereditary, and congenital conditions, HR=0.45; 95% CI, 0.27 to 0.74), glomerulonephritis, (HR=0.99; 95% CI, 0.76 to 1.11), and other (HR=0.47; 95% CI, 0.40 to 0.57). Additionally, increased risks for CV hospitalization and mortality were associated with lack of preemptive transplant compared with hemodialysis (hospital: HR=14.24; 95% CI, 5.92 to 34.28]; mortality: HR=13.64; 95% CI, 8.79 to 21.14]) and peritoneal dialysis [hospital: HR=8.47; 95% CI, 3.50 to 20.53]; mortality: HR=7.86; 95% CI, 4.96 to 12.45]). Nephrology care prior to ESRD suggests an associated with lower risk for CV mortality (HR=0.77; 95% CI, 0.70 to 0.85]).

“These findings provide the basis for continued rigorous evaluation of CVD disease in young adults with incident ESRD,” the researchers wrote “Identified modifiable risk factors may also be future targets for interventions. Together, these steps may lead to improved implementation of age-appropriate treatment and patient management strategies and overall cardiovascular health of this unique population.”

Excellent work examining #cardiovascular outcomes in #patients under 30 with end-stage kidney disease. CVD mortality risk may be 500x that of age matched controls! Pre-existing nephrology care associated with lower risk. https://t.co/MVCjyJNPnB

— Richard Fish (@Rsfish190) March 21, 2019

Risk of cardiovascular disease and mortality in young adults with end-stage renal disease: An analysis of the US Renal Data System @MDLinx https://t.co/yEvjJ5mlzG

— J.Robinson (@KidneyMentor) March 22, 2019