Additional effect of hemodialysis on mortality estimated from renal function in ischemic heart disease

Area of Science:

• Nephrology
• Cardiology
• Clinical Medicine

Background:

• Ischemic heart disease (IHD) and chronic kidney disease (CKD) frequently coexist.
• Hemodialysis is a common treatment for end-stage renal disease, but its impact on mortality in IHD patients is debated.

Purpose of the Study:

• To investigate whether hemodialysis increases mortality in patients with ischemic heart disease beyond the mortality predicted by their estimated glomerular filtration rate (eGFR).

Main Methods:

• A cohort of 1621 patients with IHD (angina pectoris, STEMI, or NSTEMI) was analyzed.
• Mortality risk was estimated using a logit model based on eGFR.
• The mortality probability of patients on hemodialysis was compared against the estimated mortality curves.

Main Results:

• The mortality probability for hemodialysis patients intersected the estimated mortality curves at varying eGFR thresholds: 5.7 mL/min/1.73 m² (angina), 31.3 mL/min/1.73 m² (STEMI), and 45.9 mL/min/1.73 m² (NSTEMI).
• These findings indicate that hemodialysis did not introduce an additional mortality risk beyond the established relationship between eGFR and mortality.

Conclusions:

• Hemodialysis does not appear to confer an additional adverse impact on mortality in patients with ischemic heart disease.
• The study suggests that the mortality risk in these patients is primarily driven by their underlying renal function (eGFR).