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

Yıl 2025, Cilt: 6 Sayı: 5, 536 - 543, 24.10.2025

Muhammed Ali Coşkuner , Gökhan Köker

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

Bu çalışma için etik onay, Antalya Eğitim ve Araştırma Hastanesi Etik Kurulu’ndan alınmıştır (karar no: 13/21, 31 Temmuz 2025 tarihli) ve çalışma Helsinki Bildirgesi ilkelerine uygun olarak yürütülmüştür. Çalışma retrospektif olarak tasarlandığından, hastalardan yazılı bilgilendirilmiş onam formu alınmamıştır.

Destekleyen Kurum

yok

Teşekkür

yok

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

Öz

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.

Anahtar Kelimeler

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

Etik Beyan

Ethical approval for this study was obtained from the Antalya Training and Research Hospital Ethics Committee (decision no: 13/21, dated 31 July 2025), and the study was conducted in accordance with the principles of the Declaration of Helsinki. Because the study was designed retrospectively, no written informed consent form was obtained from patients.

Destekleyen Kurum

None

Teşekkür

None

Kaynakça

• Toker Dincer Z, Dincer MT, Yalin SF, Trabulus S, Seyahi N, Altiparmak MR. Renal and patient outcomes of emergency hemodialysis in elderly individuals: a retrospective cohort study. Int Urol Nephrol. 2024;56(12): 3869-3876. doi:10.1007/s11255-024-04145-y
• Rosedee NA, Mohd Fauzi MF, Nik Ab Rahman NH. Predictive factors of adverse clinical outcomes among patients receiving emergency hemodialysis in emergency department. J Emerg Critl Care Med. 2024;8: 22-22. doi:10.21037/jeccm-23-165
• Kellum JA, Lameire N, Aspelin P, et al. Kidney disease: improving global outcomes (KDIGO) acute kidney injury work group. KDIGO clinical practice guideline for acute kidney injury. Kidney Int Suppl (2011). 2012;2(1):1-138. doi:10.1038/kisup.2012.1
• Johansen KL, Gilbertson DT, Li S, et al. US renal data system 2023 annual data report: epidemiology of kidney disease in the United States. Am J Kidney Dis. 2024;83(4):A8-A13. doi:10.1053/j.ajkd.2024.01.001
• Herrera-Añazco P, Ortiz PJ, Peinado JE, et al. In-hospital mortality among incident hemodialysis older patients in Peru. Int Health. 2020; 12(2):142-147. doi:10.1093/inthealth/ihz037
• Noppakun K, Nochaiwong S, Tantraworasin A, et al. Mortality rates and a clinical predictive model for the elderly on maintenance hemodialysis: a large observational cohort study of 17,354 Asian patients. Am J Nephrol. 2024;55(2):136-145. doi:10.1159/000535669
• Bae EH, Kim HY, Kang YU, Kim CS, Ma SK, Kim SW. Risk factors for in-hospital mortality in patients starting hemodialysis. Kidney Res Clin Pract. 2015;34(3):154-159. doi:10.1016/j.krcp.2015.07.005
• McAdams-DeMarco MA, Law A, Salter ML, et al. Frailty as a novel predictor of mortality and hospitalization in individuals of all ages undergoing hemodialysis. J Am Geriatr Soc. 2013;61(6):896-901. doi:10. 1111/jgs.12266
• Kahindo CK, Mukuku O, Mokoli VM, Sumaili EK, Wembonyama SO, Tsongo ZK. Predictors of mortality in adults with acute kidney injury requiring dialysis: a cohort analysis. Int J Nephrol. 2022;2022:7418955. doi:10.1155/2022/7418955
• Loutradis C, Pickup L, Law JP, et al. Acute kidney injury is more common in men than women after accounting for socioeconomic status, ethnicity, alcohol intake and smoking history. Biol Sex Differ. 2021;12(1):30. doi:10.1186/s13293-021-00373-4
• Chou CL, Zheng CM, Chiu HW, et al. Impact of acute kidney injury, co-existing with and without chronic kidney disease on the short-term adverse outcomes following atherosclerotic cardiovascular disease events in patients with diabetes. J Multidiscip Healthc. 2025;18:2019-2037. doi:10.2147/JMDH.S515884
• Park YW, Yun D, Yu Y, et al. Intradialytic hypotension and worse outcomes in patients with acute kidney injury requiring intermittent hemodialysis. Kidney Res Clin Pract. 2024. doi:10.23876/j.krcp.23.188
• Gettings LG, Reynolds HN, Scalea T. Outcome in post-traumatic acute renal failure when continuous renal replacement therapy is applied early vs. late. Intensive Care Med. 1999;25(8):805-813. doi:10.1007/s001340050956
• Tanimoto S, Nakashima A, Kato K. et al. Impact of blood urea nitrogen to creatinine ratio on infectious events, cardiovascular events, and all-cause mortality in patients with hemodialysis: a retrospective cohort study. Ren Replace Ther. 2025;11:60. doi:10.1186/s41100-025-00649-0
• Li Q, Zhao M, Du J, Wang X. Outcomes of renal function in elderly patients with acute kidney injury. Clin Interv Aging. 2017;12:153-160. doi:10.2147/CIA.S121823
• Duan S, Li Y, Yang P. Predictive value of blood urea nitrogen in heart failure: a systematic review and meta-analysis. Front Cardiovasc Med. 2023;10:1189884. doi:10.3389/fcvm.2023.1189884
• Lee YH, Lee S, Seo YJ, et al. Phosphate level predicts mortality in acute kidney injury patients undergoing continuous kidney replacement therapy and has a U-shaped association with mortality in patients with high disease severity: a multicenter retrospective study. Kidney Res Clin Pract. 2024;43(4):492-504. doi:10.23876/j.krcp.23.311
• Block G, Hulbert-Shearon T, Levin N, Port F. Association of serum phosphorus and calcium x phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis. 1998; 31(4):607-617. doi:10.1053/ajkd.1998.v31.pm9531176
• Jetanapirom R, Boonsrirat U, Geater SL, Leelawattana R, Phongphithakchai A. Impact of calcium phosphate product on acute kidney injury and mortality: a retrospective cohort study. Cureus. 2024; 16(7):e64861. doi:10.7759/cureus.64861
• Mochizuki K, Fujii T, Paul E, Anstey M, Pilcher DV, Bellomo R. Early metabolic acidosis in critically ill patients: a binational multicentre study. Crit Care Resusc. 2021;23(1):67-75. doi:10.51893/2021.1.OA6
• Zingg T, Bhattacharya B, Maerz LL. Metabolic acidosis and the role of unmeasured anions in critical illness and injury. J Surg Res. 2018;224:5-17. doi:10.1016/j.jss.2017.11.013
• Yagi K, Fujii T. Management of acute metabolic acidosis in the ICU: sodium bicarbonate and renal replacement therapy. Crit Care. 2021; 25(1):314. doi:10.1186/s13054-021-03677-4