Cardiovascular diseases morbidity and mortality among children, adolescents and young adults with dialysis therapy

Abstract

Background: The age-specific burden of cardiovascular disease (CVD) and mortality in pediatric and young adult patients with end-stage kidney disease (ESKD) remains unclear. We aimed to examine the prevalence and incidence of CVD and all-cause mortality in children and adolescents compared with adults with dialysis in Taiwan.

Methods: This retrospective observational cohort study comprised 3,910 patients with more than 2 time point receipts of dialysis therapy in a year, including 156 aged <12 years (children), 250 aged 13-20 years (adolescents), 1,036 aged 21-30 years (young adults) and 2,468 aged 31-40 years (adults) in a large healthcare delivery system in Taiwan (2003-2017). Age groups were classified by the date of first receipt of dialysis therapy. The outcomes include the composite of CVD events and any cause of death. Death-censored Cox proportional hazard models were used to evaluate the composite outcome risk of CVD in the four age groups.

Results: Among patients receiving dialysis treatment, the risk of composite CVD events [HR, 1.63 (1.22-2.19)] and mortality [HR, 1.76 (1.38-2.25)] was greater in children than the dialysis initiated in older patients. Non-atherosclerotic CVD was more prevalent, especially in younger patients, within the first 6 months after the initiation of dialysis. After 6 months of initial dialysis, the risk of atherosclerotic CVD was higher in adults than those for adolescents and children. The magnitude of CVD risk in adolescents who initiated dialysis therapy was higher in females [HR, 2.08 (1.50-2.88)] than in males [HR, 0.75 (0.52-1.10)].

Conclusion: Younger patients undergoing chronic dialysis with a higher risk of CVD events than older patients are associated with a faster onset of non-atherosclerotic CVD and a higher risk of both CVD- and non-CVD-related mortality.

Keywords: adolescents; cardiovascular disease; children; dialysis; end-stage kidney disease; young adults.

Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Copyright © 2023 Li, Tain, Kuo and Hsu.

Figures

Figure 1

Cumulative incidence of cardiovascular event and mortality over time in (A) 0–12 years of age, (B) 13–20 years of age, (C) 21–30 years, and (D) 31–40 years of age with dialysis treatment.

Figure 2

Forest plot of adjusted hazard ratio for the composite cardiovascular disease event in 0–12 years, 13–20 years, 21–30 years, and 31–40 years (reference) of age groups. The following covariates were adjusted for in the death-censored Cox proportional hazards model: Sex, type of CKD (CAKUT, non-CAKUT, and non- CKD), any congenital anomalies, baseline comorbid conditions of liver disease, severe liver disease, diabetes with and without complications, cancer, metastatic cancer, hypertension, hyperlipidemia, and AKI diagnosis.

Figure 3

Forest plot of adjusted hazard ratio for in-hospital mortality in 0–12 years, 13–20 years, 21–30 years, and 31–40 years (reference) of age groups. Persistent CVD: patients with any CVD both baseline and during the following covariates were adjusted for in the Cox proportional hazards model: Sex, type of CKD (CAKUT, non-CAKUT, and non-CKD), any congenital anomalies, baseline comorbid conditions of liver disease, severe liver disease, diabetes with and without complications, cancer, metastatic cancer, hypertension, hyperlipidemia, AKI diagnosis, and CVD at baseline and any time before death event.

Figure 4

Discharge diagnosis of cardiovascular disease among patients with in-hospital mortality Atherosclerotic CVD, coronary artery disease and infarction; Non-atherosclerotic CVD, cardiovascular/circulatory, (congestive) heart failure, atrial fibrillation/flutter, any stroke, artery disease; other CVD, other heart disease and valve disease.