CARDIOVASCULAR HOSPITALIZATIONS AND OUTCOME AMONG PATIENTS ON MAINTENANCE HEMODIALYSIS, DIAVERUM SAUDIA ARABIA EXPERIENCE.

Introduction:

Hospitalization for cardiovascular disease is common among patients receiving maintenance hemodialysis, underlying causes, and outcome predictors are underexplored.  

Methods:

Between 2016-2024 Diaverum Saudi Arabia provides hemodialysis for around (10485) patients over 40 dialysis centers. Reducing hospitalization rates and improving outcomes are integral parts of the Diaverum clinical key performance indices. We studied the pattern of cardiovascular hospitalization to define the underlying causes and outcome predictors.

Results:

Our cohort included (10485)patients with dialysis vintage Median(range) 3.7(0.8-10.2) years with a follow-up period  Median(range) 2.7(0.2-8.5) years, age M±SD (54.6±16.2) years, Male (56.8%) Diabetic (50.2%) Comorbidity index M±SD (4.85±2.3). we reported  (15323)Hospitalization episodes with a rate of 0.48 episodes per patient-years at risk of which cardiovascular-related hospitalizations accounted for (3111) 20.3%. Urgent status upon admission showed a significant progressive reduction over the follow-up period (78.8% and 39.8%) p-value <0.001 for 2016 and 2024  respectively. Mortality related to cardiovascular hospitalization was significantly higher than non-cardiovascular hospitalization (17.7% &11.2% ) p-value <0.001. Ischemic Heart Disease was the predominant cause 997(32%) followed by Congestive Heart Failure 597(19.2%) then cerebrovascular accidents ( ischemic or hemorrhagic stroke )460(14.8%). Arrhythmia accounts for 266(8.6%) and is predominantly related to tachyarrhythmias (Atrial Fibrillation)198(6.35%). Elective hospitalization for procedures 262(8.4%), remaining  causes represented 357(11.5%)and included valvular heart disease163(5.3%), peripheral vascular disease146(4.7%), hypertensive emergencies138(4.4%), venous thromboembolic events 34(1.1%), sudden cardiac arrest 39(1.2%), and myocarditis 9(0.3%). A logistic regression model including all covariates significantly associated with cardiovascular hospitalization to eliminate the confounder effect showed the following factors independently associated with a higher risk of cardiovascular hospitalization higher comorbidity index ≥ 6  HR(95%CI) 2.7(2.5-3.1) p-value <0.001, Diabetes HR(95%CI) 1.4(1.3-1.5) p-value <0.001, Catheter as vascular access HR(95%CI) 1.5(1.4-1.6) p-value <0.001, age ≥ 65 years old HR(95%CI) 1.2(1.1-1.3) p-value 0.004 with lower risk associated with online HDF compared to high flux Hemodialysis HR(95%CI) 0.64(0.6-0.7) p-value <0.001, gender and dialysis vintage did not show an independent association.

Conclusions:

Patients on maintenance hemodialysis are at higher risk of cardiovascular-related hospitalization with the leading causes being ischemic heart disease, congestive heart failure, cerebrovascular events, and arrhythmias. We found higher comorbidity index, diabetes, catheter as vascular access, and age ≥ 65 years old are independently associated with a higher rate of cardiovascular hospitalization, on online HDF  is independently associated with a lower risk of cardiovascular hospitalization.

I have no potential conflict of interest to disclose.

I did not use generative AI and AI-assisted technologies in the writing process.