High cardiovascular event rates occur within the first weeks of starting hemodialysis

Area of Science:

• Nephrology
• Cardiovascular Medicine
• Clinical Epidemiology

Background:

• Early mortality is a significant concern for patients initiating hemodialysis (HD).
• Limited data exists on the incidence and patterns of early cardiovascular events (CVEs) following HD initiation.

Purpose of the Study:

• To investigate the weekly and monthly rates of composite cardiovascular events (CVEs) and their constituents during the first two years after initiating hemodialysis.
• To identify the temporal risk patterns of CVEs post-HD initiation and associated factors during the high-risk period.

Main Methods:

• Analysis of the AROii cohort, including 6308 incident HD patients from over 300 European Fresenius Medical Care centers.
• Assessment of weekly and monthly rates of a composite CVE (including coronary artery, cerebrovascular, peripheral arterial events, congestive heart failure, and sudden cardiac death) over two years.
• Evaluation of associations between dialysis parameters (dose, blood flow, ultrafiltration) and CVEs during high-risk periods.

Main Results:

• A total of 1449 patients experienced 2405 CVEs over two years.
• The first-year CVE rate (30.2/100 person-years) was substantially higher than the second-year rate (19.4/100).
• CVE rates peaked in the first week and remained elevated for up to five months, with specific dialysis parameters linked to risk during this period.

Conclusions:

• The incidence of CVEs is markedly elevated in the initial weeks following hemodialysis initiation.
• These findings suggest that the initiation of hemodialysis itself may act as a trigger for cardiovascular events.
• Understanding and mitigating this early high-risk period is crucial for improving patient outcomes.