Mortality And Risk Factors In Dialysis Patients With Cardiovascular Disease

Background:To explore the mortality and associated risk factors in Asian dialysis patients with CVD.Also,we explore the mortality differences by dialysis modality among dialysis patients with cardiovascular disease which can help us to choose the proper dialysis modality in clinic.Methods:In this study,mortality and risk factors were investigated in 591 dialysis patients who were recruited from two dialysis centers from May 1,2009 to May 1,2014.Demographic information(age,gender,body mass index(BMI),dialysis duration),comorbidities(diabetes mellitus,hypertension,and stroke),and clinical data were collected.Clinical data and biochemical parameters included systolic blood pressure(SBP),diastolic blood pressure(DBP),mean arterial pressure(MAP),hemoglobin,serum albumin,hemoglobin Alc(HbAlc),high-sensitivity C-reactive lipoprotein(hs-CRP),phosphorus,calcium,corrected calcium,Ca×P,Kt/V,uric acid,triglycerides,total cholesterol,low-density lipoprotein cholesterol(LDL-C),and high-density lipoprotein cholesterol(HDL-C).)The Cox proportional hazards regression assessed adjusted differences in mortality risk.Univariate Cox regression was used to evaluate prognostic risks for all-cause mortality among baseline parameters in the whole population and in the CVD and non-CVD groups.Then,the significant variables from the univariate model were placed in multivariate Cox regression to further analyze possible risk factors.Survival rates were calculated using the Kaplan-Meier method,and the difference between survival rates was analyzed using the log-rank test.A Cox proportional hazards model was constructed for the CVD and non-CVD groups.Results:A total of 591 patients were enrolled in this study(mean age,52.05 ±16.46 years[SD];61.8%men;20.8%with CVD).The cumulative hazard of mortality was significantly higher in CVD patients(hazard ratio[HR],1.835;95%confidence interval[Cl],1.023-3.293;P=0.042)than in their non-CVD counterparts after adjusting for various confounders.In addition,the risk of death was higher in the CVD group than in the non-CVD group with HRs of 2.893(95%CI,1.804-4.693;P<0.001),4.072(95%CI,2.036-8.142;P<0.001),and 3.803(95%CI,1.845-7.843;P<0.001)in all patient,patients who underwent HD,and patients who underwent PD,respectively.Moreover,in CVD patients,the risk of death was significantly higher in the HD group than in the PD group(HR,1.569;95%CI,1.032-2.392;P<0.001).In non-CVD patients,the risk of death was also higher in the HD group than in the PD group(HR,1.218;95%CI,1.109-1.348;P<0.001).On multivariate Cox analysis,stroke(HR,4.574;95%CI,2.149-9.736;P<0.001)was an independent predictor of all-cause mortality in the CVD group.In the non-CVD group,diabetes mellitus(HR,2.974;95%CI,1.560-5.668;P=0.001)and elevated high-sensitivity C-reactive lipoprotein(hs-CRP)(HR,1.107;95%Cl,1.005-1.030;P=0.005)were independent predictors of all-cause mortality.On multivariate Cox analysis,CVD(HR =3.270,95%CI:1.573-6.798,P =0.002)?stroke(HR =2.479,95%CI:1.034-5.945,P=0.042)?Kt/Vwere independent predictors of all-cause mortality in the HD group.Age(HR =1.063,95%CI:1.032-1.096,P<0.001)?stroke(HR =3.980,95%CI:1.781-8.891,P =0.001)and Hb(HR =0.966,95%CI:0.945-0.987,P =0.002)were independent predictors of all-cause mortality.Conclusion:All-cause mortality was significantly higher in the CVD group than in the non-CVD group.Stroke is an independent risk factor for all-cause mortality in dialysis patients with CVD.These findings warrant further studies into preventive and interventional strategies.