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Cardiovascular and noncardiovascular mortality among patients starting dialysis
Dinanda J de Jager1, Diana C Grootendorst, Kitty J Jager
1Department of Clinical Epidemiology, Leiden University Medical Center, C7-104, PO Box 9600, 2300 RC Leiden, The Netherlands. d.j.de_jager@lumc.nl
JAMA
|October 29, 2009
Summary
Patients starting dialysis face a significantly higher overall mortality risk. This increased risk is not solely due to cardiovascular issues but also involves elevated noncardiovascular mortality rates.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- Cardiovascular mortality is the leading cause of death in dialysis patients, significantly exceeding general population rates.
- Dialysis patients experience a 10-20 fold higher mortality risk compared to the general population.
Purpose of the Study:
- To determine if the high mortality in dialysis patients stems exclusively from increased cardiovascular risk.
- To investigate whether noncardiovascular mortality is equally elevated in patients initiating dialysis.
Main Methods:
- Utilized European Renal Association-European Dialysis and Transplant Association (ERA-EDTA) Registry data (1994-2007) for 123,407 adult dialysis patients.
- Compared age-stratified mortality rates with the general European population (Eurostat) using standardized cardiovascular and noncardiovascular mortality metrics.
- Analyzed cause of death using ERA-EDTA and International Statistical Classification of Diseases, 10th Revision (ICD-10) codes.
Main Results:
- Dialysis patients exhibited significantly higher standardized cardiovascular (8.8 times) and noncardiovascular (8.1 times) mortality rates compared to the general population.
- Noncardiovascular deaths constituted a larger proportion (51%) of total mortality in dialysis patients than cardiovascular deaths (39%).
- The relative excess of cardiovascular over noncardiovascular mortality in dialysis patients was marginal (1.09).
Conclusions:
- Patients initiating dialysis face a generalized increase in mortality risk.
- The elevated mortality in dialysis patients is not exclusively driven by cardiovascular causes; noncardiovascular mortality also plays a significant role.
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