Acil hemodiyaliz gerektiren geriatrik hastalarda klinik ve biyokimyasal parametrelerin hastane içi mortalite ile ilişkisi

Abstract

Amaç: Acil hemodiyalize alınan geriatrik hastalarda hastane içi mortalite ile demografik özellikler, hemodinamik parametreler, komorbid durumlar ve rutin biyokimyasal belirteçler arasındaki ilişkiyi araştırmak. Yöntem: Bu retrospektif gözlemsel çalışmaya, Ocak 2023 ile Haziran 2025 arasında Antalya Eğitim ve Araştırma Hastanesi’nde acil hemodiyaliz uygulanan, yaş ≥65 olan 136 hasta dahil edildi. Demografik, klinik ve biyokimyasal veriler hastane bilgi sisteminden elde edildi. Birincil sonuç ölçütü hastane içi mortalite idi. İstatistiksel analizlerde ki-kare testi, Student t-testi, Mann-Whitney U testi, ROC eğrisi analizi, nokta-biseriyal korelasyon ve ikili lojistik regresyon kullanıldı. Bulgular: 136 hastanın 31’i (%22,8) hastanede yatışı sırasında kaybedildi. Sağ kalamayanlar daha ileri yaşta idi (medyan 79’a karşı 73 yıl, p = 0,010), daha düşük sistolik kan basıncına sahipti (120’ye karşı 140 mmHg, p = 0,014) ve daha yüksek kan üre azotu (89’a karşı 66 mg/dL, p = 0,025) ve serum fosfor düzeyleri (5,45’e karşı 4,20 mg/dL, p < 0,001) ile daha düşük pH değerleri (7,24’e karşı 7,28, p = 0,014) sergilediler. Lojistik regresyon analizinde ileri yaş, kronik böbrek hastalığı olmaması, düşük sistolik kan basıncı, yüksek kan üre azotu, yüksek fosfor düzeyi ve düşük pH bağımsız mortalite belirteçleri olarak doğrulandı. Serum kalsiyumu da mortalite ile mütevazı düzeyde ilişkili bulundu. Sonuç: Acil hemodiyalize alınan geriatrik hastalarda ileri yaş, kronik böbrek hastalığı olmaması, hipotansiyon, yüksek kan üre azotu, hiperfosfatemi ve ciddi metabolik asidoz, hastane içi mortalitenin anlamlı belirteçleri olarak öne çıkmaktadır. Bu bulgular, savunmasız bu popülasyonda sonuçları iyileştirmek için değiştirilebilir risk faktörlerinin erken tanınması ve yönetiminin önemini vurgulamaktadır.

Keywords

• Akut böbrek hasarı
• Hemodiyaliz
• Hastane içi mortalite
• Fosfor
• Prognostik faktörler
• Geriatri

Predictors of in-hospital mortality in elderly patients undergoing emergency hemodialysis

Abstract

Aims: To investigate the association of in-hospital mortality with demographic characteristics, hemodynamic parameters, comorbid conditions, and routine biochemical markers in geriatric patients undergoing emergency hemodialysis (HD). Methods: We retrospectively analyzed 136 patients aged ≥65 years who underwent emergency HD between January 2023 and June 2025. Demographic, clinical, and laboratory parameters were collected. Logistic regression was used to identify predictors of in-hospital mortality, and ROC curve analyses were performed to assess predictive performance. Results: Of the 136 patients, 31 (22.8%) died during hospitalization. Non-survivors were older (median 79 vs. 73 years, p=0.010), had lower systolic blood pressure (SBP) (120 vs. 140 mmHg, p=0.014), and exhibited higher blood urea nitrogen (BUN) (89 vs. 66 mg/dl, p=0.025) and serum phosphorus (5.45 vs. 4.20 mg/dl, p<0.001), along with lower pH (7.24 vs. 7.28, p=0.014). Logistic regression confirmed advanced age, absence of chronic kidney disease (CKD), low SBP, elevated BUN, high phosphorus, and low pH as independent predictors of in-hospital mortality. Serum calcium was also modestly associated with mortality. Conclusion: In geriatric patients undergoing emergency HD, advanced age, absence of CKD, hypotension, elevated BUN, hyperphosphatemia, and severe metabolic acidosis were significant predictors of in-hospital mortality. These findings highlight the importance of early recognition and management of modifiable risk factors to improve outcomes in this vulnerable population.

Keywords

• Acute kidney injury
• hemodialysis
• in-hospital mortality
• phosphorus
• prognostic factors
• elderly

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