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. 2020 Sep 1;3(9):e2016197.
doi: 10.1001/jamanetworkopen.2020.16197.

Trends in Cardiovascular Mortality Among a Cohort of Children and Young Adults Starting Dialysis in 1995 to 2015

Elaine Ku  1   2   3 , Charles E McCulloch  3 , Patrick Ahearn  4 , Barbara A Grimes  3 , Mark M Mitsnefes  5
Affiliations

Trends in Cardiovascular Mortality Among a Cohort of Children and Young Adults Starting Dialysis in 1995 to 2015

Elaine Ku et al. JAMA Netw Open. .

Abstract

Importance: Survival of patients receiving dialysis has improved during the last 2 decades. However, few studies have examined temporal trends in the attributed causes of death (especially cardiovascular-related) in young populations.

Objective: To determine temporal trends and risk of cause-specific mortality (ie, cardiovascular and infectious) for children and young adults receiving dialysis.

Design, setting, and participants: This retrospective cohort study examined the records of children and young adults (aged <30 years) starting dialysis between 1995 and 2015 according to the United States Renal Data System database. Analyses were performed between June 2019 and June 2020. Fine-Gray models were used to examine trends in risk of different cardiovascular-related deaths. Models were adjusted for age, sex, race, neighborhood income, cause of end-stage kidney disease, insurance type, and comorbidities. Analyses were performed separately for children (ie, age <18 years) and young adults (between ages 18 and 30 years). Follow-up was censored at death or administratively, and transplantation was treated as a competing event.

Exposures: Calendar year.

Main outcomes and measures: Cardiovascular cause-specific mortality.

Results: A total of 80 189 individuals (median [interquartile range] age, 24 [19-28] years; 36 259 [45.2%] female, 29 508 [36.8%] Black, and 15 516 [19.3%] Hispanic white) started dialysis and 16 179 experienced death during a median (interquartile range) of 14.3 (14.0-14.7) years of follow-up. Overall, 40.2% of deaths were from cardiovascular-related causes (6505 of 16 179 patients). In adjusted analysis, risk of cardiovascular-related death was stable initially but became statistically significantly lower after 2006 (vs 1995) in those starting dialysis as either children (subhazard ratio [SHR], 0.74; 95% CI, 0.55-1.00) or adults (SHR, 0.90; 95% CI, 0.83-0.98). Risk of sudden cardiac death improved steadily for all age groups, but to a greater degree in children (SHR, 0.31; 95% CI, 0.20-0.47) vs young adults (SHR, 0.64; 95% CI, 0.56-0.73) comparing 2015 vs 1995. Risk of stroke became statistically significantly lower around 2010 (vs 1995) for children (SHR, 0.40; 95% CI, 0.18-0.88) and young adults (SHR, 0.76; 95% CI, 0.59-0.99).

Conclusions and relevance: In this study, the risk of cardiovascular-related death declined for children and young adults starting dialysis during the last 2 decades, but trends differed depending on age at dialysis initiation and the specific cause of death. Additional studies are needed to improve risk of cardiovascular disease in young populations.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Ku reported receiving grant funding from CareDX and compensation as a consultant to Tricida, Inc during the conduct of the study. Dr McCulloch reported receiving grants from the National Institutes of Health during the conduct of the study. Dr Grimes reported receiving grants from the National Institutes of Health during the conduct of the study. No other disclosures were reported.

Figures

Figure 1.
Figure 1.. Trend in Cause-Specific Deaths Among Children and Young Adults by Calendar Year of Dialysis Initiation Using Fine-Gray Models
Shaded areas represent 95% CIs for the point estimates in young adults and children. CV indicates cardiovascular; INF, infection.
Figure 2.
Figure 2.. Trend in Cause-Specific Cardiovascular Disease-Related Deaths Among Children and Young Adults by Calendar Year of Dialysis Initiation Using Fine-Gray Models
Shaded areas represent 95% CIs for the point estimates in young adults and children. CHF indicates congestive heart failure; MI, myocardial infarction; SCD, sudden cardiac death.
See this image and copyright information in PMC

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