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Incident acute coronary syndromes in chronic dialysis patients in the United States

Fernando C Trespalacios1, Allen J Taylor, Lawrence Y Agodoa

  • 1Nephrology Service, Walter Reed Army Medical Center, Washington, DC, USA.

Kidney International
|October 10, 2002
PubMed

Insights

Patients on dialysis face high cardiovascular disease (CVD) risks. Acute coronary syndrome (ACS) incidence was 29/1000 person-years, with similar risk factors to the general population, but underutilized protective medications.

Area of Science:

  • Nephrology
  • Cardiology
  • Epidemiology

Background:

  • Patients undergoing dialysis exhibit a significantly elevated risk of cardiovascular disease (CVD).
  • The incidence and specific risk factors for acute coronary syndromes (ACS) in this dialysis population remain understudied.

Purpose of the Study:

  • To assess the incidence of acute coronary syndromes (ACS) in patients on dialysis.
  • To identify risk factors associated with incident ACS in this cohort.
  • To evaluate the role of cardioprotective medications in preventing ACS in dialysis patients.

Main Methods:

  • A historical cohort study analyzed data from 3374 patients in the USRDS Dialysis Morbidity and Mortality Study (DMMS) Wave II.
  • Cox regression analysis modeled factors associated with time to first ACS hospitalization, adjusting for comorbidities, demographics, lab values, and medications.
  • Follow-up extended from 1996 to March 2000, with censoring at renal transplantation.

Main Results:

  • The incidence of ACS was 29 per 1000 person-years.
  • Associated risk factors included older age, extreme serum cholesterol levels, prior coronary heart disease (CHD), male gender, and diabetes.
  • No significant association was found for cardioprotective medications, including statins, possibly due to underutilization.

Conclusions:

  • Dialysis patients share similar ACS risk factors with the general population.
  • Cardioprotective medications showed no significant benefit, likely due to low prescription rates in patients with known CHD.
  • Underutilization of evidence-based therapies may contribute to poor cardiovascular outcomes in dialysis patients.
Abstract

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