Comparative mortality from cardiovascular disease in patients with chrome renal failure

Abstract

Patients with chronic renal failure show an excess mortality from cardiovascular disease (CVD). Over a 4-year period (1983-1986) we have prospectively studied 305 patients (177 men, 128 women) from a geographically constrained population entering a renal replacement therapy (RRT) programme. The development of new cardiovascular events and patient survival have been documented up to the end of 1990. We have determined the incidence of CVD amongst the patients compared to the general population of the region and assessed the predictive value for future cardiovascular events of risk factors present at the start of RRT. One hundred and fourteen patients experienced a new cardiovascular event. One hundred and fifteen patients died, 89 from CVD. Stratification by age and sex identified diabetes, previous coronary heart disease, and cardiomegaly to be significantly associated with an increased risk of a cardiovascular event, and diabetes, previous coronary heart disease, and accelerated hypertension to be significantly associated with an increased risk of cardiovascular death. Mortality from CVD was 10.1 times that of the corresponding general population, and was increased 44 times for patients with diabetes. Duration of RRT did not influence mortality rates. This excessive early mortality has significant implications for RRT programmes and further research is necessary to identify individuals at risk and the modifiable risk factors that could receive targeted interventional therapy.

Ventricular Arrhythmias and Sudden Cardiac Death in End-Stage Renal Disease Patients on Chronic Hemodialysis

“…HD patients are at an increased risk of sudden cardiac death for many reasons, and among the comorbid factors that have been identified are: malnutrition, diabetes mellitus, anemia, dyskalemia, hyperparathyroidism, and preexisting CVD [2, 3, 4, 5, 6, 7]. There is also epidemiological evidence that the occurrence of clinically significant ventricular arrhythmias, particularly in the presence of underlying heart disease, may increase one’s susceptibility to an arrhythmic death [8].…”

Coronary Artery Disease Is Common in Nonuremic, Asymptomatic Type 1 Diabetic Islet Transplant Candidates

“…Because end-stage renal disease itself is associated with excess cardiovascular morbidity and mortality (8), it is unclear whether data from diabetic patients being assessed for renal transplantation can be extrapolated to ITX candidates. To date, there is a paucity of data regarding the prevalence of CAD and the performance of noninvasive investigations in type 1 diabetic patients with preserved renal function being assessed for ITX.…”

Cause of death in patients with end‐stage renal disease: assessing concordance of death certificates with registry reports

“…Despite the differences in purpose and in coding causes of death, endstage renal disease registry data are often compared with data from the general population. 4,5 Perneger and colleagues in the United States (US) discussed concordance on cause of death, for ESRD patients, between death cer tif icates and registry reports. 6 They found that these sources provided different information on causes of death and were not interchangeable.…”