What is the mortality rate for elderly hemodialysis patients with diabetes and cardiovascular disease in a specific location?

Hemodialysis Patient Mortality Rates

The annual mortality rate for hemodialysis patients is approximately 20% per year in the United States, with approximately 50% of deaths attributable to cardiovascular causes, though significant regional variations exist globally. 1

Global and Regional Mortality Rates

United States

• Annual mortality rate ranges from 17-20% per year for hemodialysis patients 1, 2
• The 1-year survival rate is 84-90%, declining to approximately 55% at 3 years and only 40% at 5 years 3
• This means only 4 out of 10 patients survive 5 years after initiating dialysis 3

China

• Overall annual mortality rate for hemodialysis patients is 3.4%, substantially lower than U.S. rates 1, 2
• Significant regional variations exist within China, with Zhejiang province showing the highest mortality at 11.2% annually 1, 2
• Peritoneal dialysis patients have a lower mortality rate of 2.3% annually 1
• In-hospital mortality for CKD patients was 2.13% in 2018 1

Japan

• Demonstrates the best outcomes globally with annual mortality rates less than 10%, which cannot be explained by statistical methodology differences alone 2

High-Risk Populations: Elderly Patients with Diabetes and Cardiovascular Disease

Age-Specific Mortality

• Elderly patients (≥70 years) experience 20% mortality in the first year alone 3
• For patients aged ≥75 years, survival rates decline sharply: 90% at 1 year, 82% at 2 years, and only 53% at 5 years 4
• Age-stratified 5-year survival for elderly patients: 45.9% (65-69 years), 37.5% (70-74 years), 28.4% (75-79 years), 24.1% (80-84 years), and 13.7% (≥85 years) 5

Cardiovascular Disease Impact

• Cardiovascular disease is present in 43-58% of dialysis patients and represents the leading cause of death, accounting for 27-28% of all deaths 1, 3
• Coronary heart disease affects 37.26% and heart failure affects 14.51% of hemodialysis patients 2
• Cardiovascular causes account for approximately 50% of the 20% annual mortality rate 1

Diabetes Mellitus

• Diabetes is an independent predictor of mortality in elderly hemodialysis patients 6, 4, 5
• In end-stage kidney disease patients with diabetes, HbA1c ≥10% associates with 41% higher all-cause mortality and 73% higher cardiovascular mortality compared to HbA1c 5-6% 7
• The prevalence of diabetes among dialysis patients ranges from 17.88-18.33% 1

Critical Prognostic Factors

Comorbidity Burden

• The Charlson comorbidity index is the strongest independent predictor of mortality in elderly dialysis patients 4
• Patients with higher comorbidity burden have significantly lower survival rates regardless of age 4
• Independent mortality predictors include: myocardial infarction, congestive heart failure, peripheral vascular disease, cerebrovascular disease, dementia, chronic pulmonary disease, liver disease, and malignancy 5

Vascular Access Type

• Patients with arteriovenous fistula have 50% 5-year survival, compared to 41.2% with prosthetic graft and 42.9% with persistent catheter use 3
• Catheter use confers 51% increased mortality compared to arteriovenous fistulas 3
• Central venous catheter use is independently associated with increased mortality (OR 1.53) 6

Geriatric Impairments

• Frailty prevalence in hemodialysis patients is 46% and confers a 2-fold increased risk of all-cause mortality (HR 2.02) 8
• Functional impairment increases mortality risk by 45% (OR 1.45) 6
• Cognitive impairment increases mortality risk by 46% (OR 1.46) 6
• Falls are associated with 14% increased mortality (OR 1.14) 6

Nutritional Status

• Low body mass index confers a 43% increased mortality risk (OR 1.43), paralleling frailty as a marker of early death 6
• Low albumin concentration is independently associated with high mortality risk 9

Dialysis-Related Factors

• Early-start dialysis (versus late-start) is associated with 18% increased mortality (OR 1.18) 6
• Low Kt/V (inadequate dialysis dose) is associated with increased mortality 9

Common Pitfalls and Clinical Considerations

Critical caveat: Unlike the general population, age alone does not independently influence mortality or admission rates in elderly dialysis patients when comorbidity burden is accounted for 4. The Charlson comorbidity index, not chronological age, is the primary driver of outcomes.

Important consideration: Advanced age should not be regarded as an excluding factor for initiating dialysis, as outcomes are primarily determined by comorbidity burden rather than age itself 4.

Vascular access preparation: Arteriovenous fistula or graft preparation when starting hemodialysis should be strongly considered in elderly patients with fewer comorbidities, as catheter use significantly increases mortality risk 9.