Division of Nephrology, Department of Internal Medicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Institute for Translational Research in Biomedicine, Kaohsiung Chang Gung Memorial Hospital, Chang Gung University College of Medicine, Kaohsiung, Taiwan.
Front Public Health. 2023 Apr 12;11:1142414. doi: 10.3389/fpubh.2023.1142414. eCollection 2023.
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.
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.
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)].
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.
儿科和青年终末期肾病（ESKD）患者心血管疾病（CVD）的特定年龄负担和死亡率仍不清楚。我们旨在研究台湾透析患者中儿童和青少年与成人相比 CVD 的患病率和发病率以及全因死亡率。
这项回顾性观察性队列研究包括在一年内接受超过 2 次透析治疗的 3910 名患者，其中 156 名年龄<12 岁（儿童），250 名年龄 13-20 岁（青少年），1036 名年龄 21-30 岁（青年）和 2468 名年龄 31-40 岁（成人），在台湾的一个大型医疗保健系统中（2003-2017 年）。年龄组按首次接受透析治疗的日期分类。结果包括 CVD 事件和任何原因死亡的复合结果。使用死亡校正的 Cox 比例风险模型评估四个年龄组的 CVD 复合结局风险。
在接受透析治疗的患者中，与在较年长患者开始透析相比，儿童的 CVD 复合事件[HR，1.63（1.22-2.19）]和死亡率[HR，1.76（1.38-2.25）]风险更高。在开始透析后的前 6 个月内，非动脉粥样硬化性 CVD 的患病率更高，尤其是在年轻患者中。在初始透析后 6 个月后，与青少年和儿童相比，成人的动脉粥样硬化性 CVD 风险更高。开始透析治疗的青少年的 CVD 风险更高，女性[HR，2.08（1.50-2.88）]高于男性[HR，0.75（0.52-1.10）]。
与老年患者相比，接受慢性透析治疗且 CVD 事件风险较高的年轻患者，非动脉粥样硬化性 CVD 的发病更快，CVD 和非 CVD 相关死亡率的风险更高。
