BACKGROUND: Cardiovascular diseases are the most common causes of death among hemodialysis (HD) patients, yet the risk factors for these events have not been well established. Our study objective was to determine predictors of cardiovascular mortality, considering the non-traditional/disease-related and treatment-related/ cardiovascular risk factor in HD patients. MATERIAL AND METHODS: Disease-related cardiovascular risk factors, such as anaemia, calcium-phosphate disorders, nutrition-inflammation and treatment/dialysis-related cardiovascular risk factors such as HD dose, using the index Kt/V were analyzed in 214 patients on HD. Mortality was monitored prospectively over a two year period. RESULTS: Fifty-three of the 214 HD patients died during the follow-up period and the main cause of death was cardiovascular events (56.6%), followed by infection/sepsis (26.4%). The patients who died were significantly older than those alive, had significantly lower serum levels of hemoglobin (Hb), albumin and Kt/V. Serum levels of calcium, C-reactive protein (CRP) and fibrinogen were significantly higher in patients who died during the follow-up period. Kaplan-Meier analysis showed that the all cause and cardiovascular mortality was considerably higher in patients with Hb<110 g/l, albumin <40 g/l, CRP>8 mg/l and spKt/V<1.2 (log rank, p=0.000/p=0.000, p=0.000/ p=0.001, p=0.000/p=0.000, p=0.000/p=0.000), respectively. No difference in cardiovascular mortality was observed between the fibrinogen <4 g/l> levels. High CRP, low Hb levels and low spKt/V were significant predictors of all-cause mortality, but low albumin and high fibrinogen levels were not in the Cox proportional hazards analysis. When only cardiovascular mortality was entered into the Cox model, high CRP and low Hb levels were the only significant predictors for mortality. CONCLUSIONS: It can be concluded that, inflammation (elevated CRP) and anaemia (decreased Hb), were identified as significant independent non-traditional, disease-related cardiovascular risk factors that predict cardiovascular mortality in HD patients.
BACKGROUND:Cardiovascular diseases are the most common causes of death among hemodialysis (HD) patients, yet the risk factors for these events have not been well established. Our study objective was to determine predictors of cardiovascular mortality, considering the non-traditional/disease-related and treatment-related/ cardiovascular risk factor in HDpatients. MATERIAL AND METHODS: Disease-related cardiovascular risk factors, such as anaemia, calcium-phosphate disorders, nutrition-inflammation and treatment/dialysis-related cardiovascular risk factors such as HD dose, using the index Kt/V were analyzed in 214 patients on HD. Mortality was monitored prospectively over a two year period. RESULTS: Fifty-three of the 214 HDpatients died during the follow-up period and the main cause of death was cardiovascular events (56.6%), followed by infection/sepsis (26.4%). The patients who died were significantly older than those alive, had significantly lower serum levels of hemoglobin (Hb), albumin and Kt/V. Serum levels of calcium, C-reactive protein (CRP) and fibrinogen were significantly higher in patients who died during the follow-up period. Kaplan-Meier analysis showed that the all cause and cardiovascular mortality was considerably higher in patients with Hb<110 g/l, albumin <40 g/l, CRP>8 mg/l and spKt/V<1.2 (log rank, p=0.000/p=0.000, p=0.000/ p=0.001, p=0.000/p=0.000, p=0.000/p=0.000), respectively. No difference in cardiovascular mortality was observed between the fibrinogen <4 g/l> levels. High CRP, low Hb levels and low spKt/V were significant predictors of all-cause mortality, but low albumin and high fibrinogen levels were not in the Cox proportional hazards analysis. When only cardiovascular mortality was entered into the Cox model, high CRP and low Hb levels were the only significant predictors for mortality. CONCLUSIONS: It can be concluded that, inflammation (elevated CRP) and anaemia (decreased Hb), were identified as significant independent non-traditional, disease-related cardiovascular risk factors that predict cardiovascular mortality in HDpatients.
Authors: Trinh B Pifer; Keith P McCullough; Friedrich K Port; David A Goodkin; Bradley J Maroni; Philip J Held; Eric W Young Journal: Kidney Int Date: 2002-12 Impact factor: 10.612
Authors: Eric W Young; Justin M Albert; Sudtida Satayathum; David A Goodkin; Ronald L Pisoni; Takashi Akiba; Tadao Akizawa; Kiyoshi Kurokawa; Jürgen Bommer; Luis Piera; Friedrich K Port Journal: Kidney Int Date: 2005-03 Impact factor: 10.612
Authors: A Besarab; W K Bolton; J K Browne; J C Egrie; A R Nissenson; D M Okamoto; S J Schwab; D A Goodkin Journal: N Engl J Med Date: 1998-08-27 Impact factor: 91.245
Authors: Francesco Locatelli; Ronald L Pisoni; Christian Combe; Juergen Bommer; Vittorio E Andreucci; Luis Piera; Roger Greenwood; Harold I Feldman; Friedrich K Port; Philip J Held Journal: Nephrol Dial Transplant Date: 2004-01 Impact factor: 5.992
Authors: Garabed Eknoyan; Gerald J Beck; Alfred K Cheung; John T Daugirdas; Tom Greene; John W Kusek; Michael Allon; James Bailey; James A Delmez; Thomas A Depner; Johanna T Dwyer; Andrew S Levey; Nathan W Levin; Edgar Milford; Daniel B Ornt; Michael V Rocco; Gerald Schulman; Steve J Schwab; Brendan P Teehan; Robert Toto Journal: N Engl J Med Date: 2002-12-19 Impact factor: 91.245