Comorbidity and Malnutrition as Key Determinants of Mortality in Elderly Haemodialysis Patients: A One-Year Observational Study

IF 9.1 1区医学 Q1 GERIATRICS & GERONTOLOGY

Journal of Cachexia Sarcopenia and Muscle Pub Date : 2025-09-24 DOI:10.1002/jcsm.70062

M. L. Sanchez-Tocino, S. Mas-Fontao, E. González-Parra, P. Manso, M. Burgos, D. Carneiro, M. Pereira, C. Pereira, A. Lopez-González, M. D. Arenas, on behalf the renal foundation work team

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引用次数: 0

Abstract

Background

In elderly haemodialysis patients, poor functional status correlates with malnutrition, morbidity and mortality. This study aimed to assess 1-year survival in an elderly haemodialysis population and evaluate the predictive capacity of commonly used scales for comorbidity, malnutrition, dependence and frailty.

Methods

We conducted a 1-year observational study (2022) on prevalent haemodialysis patients aged > 75 years with > 3 months of treatment. Mortality was assessed during the follow-up. We analysed sociodemographic, dialysis-related, analytical and lifestyle variables. Additionally, we evaluated comorbidity (Charlson), dependence (Barthel), malnutrition-inflammation (MIS scale) and frailty (FRIED). Statistical analysis included comparisons between continuous variables using the Mann–Whitney U test or Student's t test, based on normality distribution. Categorical variables were compared using the chi-square test. Kaplan–Meier survival analysis with log-rank test was used to compare survival curves. Multivariate analysis was performed using Cox proportional hazards models, adjusting for confounders including dialysis adequacy and underlying kidney disease aetiology. Optimal cutoff points for predicting mortality were determined using receiver operating characteristic (ROC) curves.

Results

A total of 107 haemodialysis patients (57% male, mean age 81.3 ± 4.53 years, mean time on haemodialysis 51.71 ± 51.04 months) were included. Sixteen patients (15%) died within 1 year. Deceased patients were older (83.94 ± 4.52 vs. 80.34 ± 4.39 years, p = 0.011) and had longer dialysis duration (76.46 ± 54.73 vs. 47.35 ± 49.4 months, p = 0.035), lower albumin (3.51 ± 0.54 vs. 3.86 ± 0.31 g/dL, p < 0.001) and lower creatinine levels (5.48 ± 1.12 vs. 6.50 ± 1.67 mg/dL, p = 0.021). They scored higher on all four scales analysed: Charlson (10.94 ± 1.81 vs. 8.95 ± 1.92, p < 0.001), MIS (11.31 ± 4.22 vs. 6.07 ± 3.27, p < 0.001), Barthel (52.50 ± 27.2 vs. 78.41 ± 23.11, p < 0.001), and FRIED (3.19 ± 1.05 vs. 2.18 ± 1.32, p = 0.005). Institutionalization (p = 0.004), inability to walk (p < 0.001) and stretcher transport (p < 0.001) were also significantly associated with mortality. The optimal cutoff points for predicting mortality were Charlson index ≥ 9.5 (AUC 0.788, 95% CI: 0.65–0.88), MIS ≥ 7.5 (AUC 0.844, 95% CI: 0.73–0.93), Barthel ≤ 67.5 (AUC 0.79, 95% CI: 0.68–0.79) and FRIED ≥ 2.5 (AUC 0.719, 95% CI: 0.56–0.83). In multivariable analysis, Charlson ≥ 9.5 (HR 2.75, 95% CI: 0.83–9.06, p = 0.096) and MIS ≥ 7.5 (HR 8.15, 95% CI: 1.10–60.58, p = 0.040) remained significant predictors of mortality.

Conclusions

The Charlson, Barthel, MIS and FRIED scales are useful tools for predicting mortality in elderly haemodialysis patients, with defined cutoff points for increased mortality risk. We have defined specific cutoff points that determine increased mortality risk in this population. However, comorbidity and malnutrition showed the strongest independent predictive value. These findings highlight the need for targeted interventions to address malnutrition and comorbidity in this vulnerable population.

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合并症和营养不良是老年血液透析患者死亡率的关键决定因素：一项为期一年的观察性研究。

在老年血液透析患者中，不良的功能状态与营养不良、发病率和死亡率相关。本研究旨在评估老年血液透析人群的1年生存率，并评估常用量表对合并症、营养不良、依赖性和虚弱的预测能力。方法：我们对年龄在50 ~ 75岁的血液透析患者进行了为期1年的观察性研究（2022年），患者接受了3个月的治疗。在随访期间评估死亡率。我们分析了社会人口统计学、透析相关、分析性和生活方式变量。此外，我们评估了合并症（Charlson）、依赖性（Barthel）、营养不良-炎症（MIS）和虚弱（FRIED）。统计分析包括使用基于正态分布的Mann-Whitney U检验或Student's t检验对连续变量进行比较。分类变量比较采用卡方检验。采用Kaplan-Meier生存分析和log-rank检验比较生存曲线。采用Cox比例风险模型进行多变量分析，调整透析充分性和潜在肾脏疾病病因等混杂因素。使用受试者工作特征（ROC）曲线确定预测死亡率的最佳截止点。结果共纳入血液透析患者107例（男性57%，平均年龄81.3±4.53岁，平均透析时间51.71±51.04个月）。16例患者（15%）在1年内死亡。死亡患者年龄较大（83.94±4.52岁比80.34±4.39岁，p = 0.011），透析时间较长（76.46±54.73个月比47.35±49.4个月，p = 0.035），白蛋白水平较低（3.51±0.54比3.86±0.31 g/dL, p < 0.001），肌酐水平较低（5.48±1.12比6.50±1.67 mg/dL, p = 0.021）。他们在所有四个量表得分高分析:Charlson(10.94±1.81和8.95±1.92,p < 0.001),管理信息系统(11.31±4.22和6.07±3.27,p < 0.001), Barthel(52.50±27.2和78.41±23.11,p < 0.001),和油炸(3.19±1.05和2.18±1.32,p = 0.005)。住院（p = 0.004）、无法行走（p < 0.001）和担架运输（p < 0.001）也与死亡率显著相关。预测死亡率的最佳截止点为Charlson指数≥9.5 （AUC 0.788, 95% CI: 0.65-0.88）、MIS≥7.5 （AUC 0.844, 95% CI: 0.73-0.93）、Barthel≤67.5 （AUC 0.79, 95% CI: 0.68-0.79）和FRIED≥2.5 （AUC 0.719, 95% CI: 0.56-0.83）。在多变量分析中，Charlson≥9.5 （HR 2.75, 95% CI: 0.83-9.06, p = 0.096）和MIS≥7.5 （HR 8.15, 95% CI: 1.10-60.58, p = 0.040）仍然是死亡率的显著预测因子。结论Charlson， Barthel， MIS和FRIED量表是预测老年血液透析患者死亡率的有用工具，具有明确的死亡风险增加的截止点。我们已经确定了确定这一人群死亡风险增加的具体截止点。然而，合并症和营养不良表现出最强的独立预测价值。这些发现突出表明，有必要采取有针对性的干预措施，解决这一弱势群体的营养不良和合并症问题。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of Cachexia Sarcopenia and Muscle MEDICINE, GENERAL & INTERNAL-

CiteScore

13.30

自引率

12.40%

发文量

234

审稿时长

16 weeks

期刊介绍： The Journal of Cachexia, Sarcopenia and Muscle is a peer-reviewed international journal dedicated to publishing materials related to cachexia and sarcopenia, as well as body composition and its physiological and pathophysiological changes across the lifespan and in response to various illnesses from all fields of life sciences. The journal aims to provide a reliable resource for professionals interested in related research or involved in the clinical care of affected patients, such as those suffering from AIDS, cancer, chronic heart failure, chronic lung disease, liver cirrhosis, chronic kidney failure, rheumatoid arthritis, or sepsis.