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Should we still focus that much on cardiovascular mortality in end stage renal disease patients? The CONvective
Claire H den Hoedt1, Michiel L Bots, Muriel P C Grooteman
1Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
Insights
Cardiovascular disease is not the leading cause of death in end-stage renal disease patients, with infection and dialysis withdrawal being significant factors. Older patients face equal risks from cardiovascular and non-cardiovascular causes, highlighting the need to study dialysis withdrawal.
Area of Science:
- Nephrology
- Public Health
- Epidemiology
Background:
- End-stage renal disease (ESRD) patients have a higher mortality risk compared to the general population.
- The primary cause of death in ESRD patients has historically been cardiovascular disease.
- Understanding contemporary causes of death in ESRD is crucial for improving patient outcomes.
Purpose of the Study:
- To determine the distribution of causes of death in the CONTRAST cohort of chronic hemodialysis patients.
- To compare cardiovascular mortality in ESRD patients with other populations.
- To identify factors associated with dialysis withdrawal.
Main Methods:
- Analysis of data from the CONTRAST randomized controlled trial (n=714).
- Adjudication of causes of death for patients on chronic hemodialysis.
- Comparison of mortality data with the Dutch dialysis registry and the general Dutch population.
Main Results:
- Cardiovascular disease accounted for 32% of deaths, infection for 22%, and dialysis withdrawal for 23% in the CONTRAST cohort.
- Proportional cardiovascular mortality in ESRD patients was similar to the general population.
- Patients who withdrew from dialysis were older, had more comorbidities, and lower quality of life.
Conclusions:
- While absolute mortality is higher, the proportion of cardiovascular deaths in prevalent ESRD is comparable to the general population.
- In older hemodialysis patients, cardiovascular and non-cardiovascular death risks are equally significant.
- Dialysis withdrawal is a critical factor requiring further attention and research in ESRD populations.
Background:
We studied the distribution of causes of death in the CONTRAST cohort and compared the proportion of cardiovascular deaths with other populations to answer the question whether cardiovascular mortality is still the principal cause of death in end stage renal disease. In addition, we compared patients who died from the three most common death causes. Finally, we aimed to study factors related to dialysis withdrawal.
Methods:
We used data from CONTRAST, a randomized controlled trial in 714 chronic hemodialysis patients comparing the effects of online hemodiafiltration versus low-flux hemodialysis. Causes of death were adjudicated. The distribution of causes of death was compared to that of the Dutch dialysis registry and of the Dutch general population.
Results:
In CONTRAST, 231 patients died on treatment. 32% died from cardiovascular disease, 22% due to infection and 23% because of dialysis withdrawal. These proportions were similar to those in the Dutch dialysis registry and the proportional cardiovascular mortality was similar to that of the Dutch general population. cardiovascular death was more common in patients <60 years. Patients who withdrew were older, had more co-morbidity and a lower mental quality of life at baseline. Patients who withdrew had much co-morbidity. 46% died within 5 days after the last dialysis session.
Conclusions:
Although the absolute risk of death is much higher, the proportion of cardiovascular deaths in a prevalent end stage renal disease population is similar to that of the general population. In older hemodialysis patients cardiovascular and non-cardiovascular death risk are equally important. Particularly the registration of dialysis withdrawal deserves attention. These findings may be partly limited to the Dutch population.
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