| The incidence of kidney failure (KF) has increased substantially over the past 30 years. During this same time period marked improvements in the short and long-term survival after acute myocardial infarction (MI) and stroke have been reported. Because MI and stroke survivors have high prevalence of KF risk factors it has been proposed that improved MI and stroke survival may be responsible for the increase in KF incidence. However, there have been no rigorous studies exploring reasons for the increase in KF incidence.; Using data from a population-based case-control study and three national data sets, this dissertation examines the risk of KF among persons with a history of MI and stroke and the impact of improved MI and stroke survival on KF incidence. During 1990, the incidence of KF was estimated to be 1,338 and 1,800 per million for MI and stroke survivors in the United States, respectively. In contrast, the estimated incidence of KF was 235 per million persons without a history of either MI or stroke. After adjustment for age, race, sex, and diabetes mellitus, the relative risks of KF associated with a history of MI and stroke were 1.96 (95% CI 1.7, 2.2) and 2.05 (95% CI: 1.8, 2.2), respectively. Results from a population-based case control study performed were similar; after adjustment for 10 variables the relative risk of KF associated with a history of MI and stroke was 1.6 (95% CI: 0.7, 3.3) and 7.2 (2.2, 23.2), respectively.; The age-specific prevalence MI remained stable between 1971 and 1994. In contrast, the age specific prevalence of stroke in the U.S. increased. The number of MI and stroke survivors increased by 1.3 million during this period, primarily as a result of the growth and aging of the United States population.; However, the additional 1.3 million MI and stroke survivors appear to explain only 5% of the increased number of KF cases. Reasons other than improved MI and stroke survival appear to account for the majority of MI and stroke survival in the US. |
