da Costa Laurisson Albuquerque, Faro Andre, Valverde Thaisa Leite, Tungsanga Somkanya, Bello Aminu K
Health Psychology Laboratory (GEPPS), Department of Psychology, Federal University of Sergipe, São Cristóvão, Sergipe, Brazil.
University Hospital of Sergipe, Federal University of Sergipe, Aracaju, Sergipe, Brazil.
PLoS One. 2025 Aug 18;20(8):e0330030. doi: 10.1371/journal.pone.0330030. eCollection 2025.
In the last decade, there has been an increase in the number of older adults diagnosed with kidney failure in Brazil. Anecdotal reports suggest that older adults receiving hemodialysis (HD) face a higher risk of adverse outcomes. This study aims to investigate adverse clinical outcomes and associated factors among adults over age 60 who received chronic HD at a single center in northeastern Brazil.
We conducted a retrospective cohort of older adults undergoing HD at a center in Aracaju, Sergipe, Brazil, from October 1, 2019 to March 1, 2024. Multivariable Cox regression analysis was performed to examine the associations with various risk factors for all-cause mortality. A binomial logistic regression model was leveraged for Major Cardiovascular Events (MACE) and all-cause hospitalization.
Among the 950 adults, 392 individuals over age 60 were included in our sample (median age: 68.5 years, IQR: 64-75; male: 63%). Diabetes was the leading cause of kidney failure. The total number of deaths was 157 (40.1%), primarily due to infection (n = 60, 38.2%). Multivariable analysis indicated that increased age was independently associated with all-cause mortality [HR = 1.07 (1.02-1.09), p = 0.001], while fistula use was associated with reduced mortality risk [HR = 0.36 (0.19-0.68), p = 0.02]. Although hospitalization rate increased with age, this relationship is not statistically significant. Health insurance and hypertension increased hospitalization risk, whereas fistula use was protective. Previous history of cardiovascular disease (CVD) and low serum albumin were associated with MACE. The bloodstream infection rate was 0.18 episode/patient-year, predominantly due to gram-positive organisms, with coagulase-negative Staphylococcus being the most common.
Among patients undergoing HD, older age is associated with a high risk of all-cause mortality. Fistula use appeared to be protective against all-cause mortality and hospitalization. Well-designed prospective studies are needed to clarify factors impacting adverse outcomes among older dialysis patients in Brazil.
在过去十年中，巴西被诊断患有肾衰竭的老年人数量有所增加。轶事报告表明，接受血液透析（HD）的老年人面临更高的不良后果风险。本研究旨在调查巴西东北部一个单一中心接受慢性HD的60岁以上成年人的不良临床结局及相关因素。
我们对2019年10月1日至2024年3月1日在巴西塞尔希培州阿拉卡茹市一个中心接受HD的老年人进行了回顾性队列研究。进行多变量Cox回归分析以检验与全因死亡率的各种风险因素的关联。对主要心血管事件（MACE）和全因住院使用二项逻辑回归模型。
在950名成年人中，我们的样本包括392名60岁以上的个体（中位年龄：68.5岁，四分位间距：64 - 75；男性：63%）。糖尿病是肾衰竭的主要原因。死亡总数为157人（40.1%），主要原因是感染（n = 60，38.2%）。多变量分析表明，年龄增长与全因死亡率独立相关[风险比（HR）= 1.07（1.02 - 1.09），p = 0.001]，而使用动静脉内瘘与降低死亡风险相关[HR = 0.36（0.19 - 0.68），p = 0.02]。虽然住院率随年龄增加，但这种关系在统计学上不显著。医疗保险和高血压增加住院风险，而动静脉内瘘的使用具有保护作用。心血管疾病（CVD）既往史和低血清白蛋白与MACE相关。血流感染率为0.18次/患者年，主要由革兰氏阳性菌引起，凝固酶阴性葡萄球菌最为常见。
在接受HD的患者中，年龄较大与全因死亡率高风险相关。使用动静脉内瘘似乎对全因死亡率和住院有保护作用。需要设计良好的前瞻性研究来阐明影响巴西老年透析患者不良结局的因素。
