Age, Gender and Diabetes as Risk Factors for Early Deaths in Dialysis Patients: A Systematic Review

Abstract

Objective: To study the impact of age, gender and presence of diabetes (any type) on the risk of early deaths (180-day mortality) in patients starting long-term hemodialysis (HD) therapy.

Design: systematic review of literature

Setting: Out-patient (non-hospitalised), community-based HD therapy world-wide

Participants: patients with advanced chronic kidney disease (CKD) starting long-term HD treatment for end-stage renal disease (ESRD)

Methods: Medline and EMBASE were searched for studies published between 1/1/1985 and 31/12/2017. Observational studies involving adult subjects commencing HD were included. Data extracted included population characteristics and settings. In addition, patient or treatment related factors studied with reference to their relationship with the risk of early mortality were documented. The Quality in Prognosis Studies tool was used to assess risk of bias in individual studies. Findings were summarised and a narrative account was drawn.

Results: 26 studies (combined population 1,098,769; representing 287,085 person-years of observation for early mortality) were included. There were 17 cohort and 9 case-control studies. Risk of bias was low in 13 and high in a further 13 studies. Patients who died in the early period were older than those who survived. Mortality rates increased with advancing age. Female gender was associated with slightly increased early mortality rates in larger and higher quality studies. The available data showed conflicting results in relation to the association of diabetes and risk of early mortality.

Conclusions: This systematic review evaluates the impact of key demographic and co-morbid factors on risk of early mortality in patients starting maintenance HD. The information could help in delivering more tailored prognostic information and planning of future interventions.