Kidney replacement therapy: trends in incidence, treatment, and outcomes of myocardial infarction and stroke in a...

Area of Science:

• Cardiology
• Nephrology
• Public Health

Background:

• Patients with kidney failure face elevated cardiovascular disease (CVD) risks.
• Temporal trends in myocardial infarction (MI) and stroke incidence are declining in the general population, but not well-established in kidney failure cohorts.
• This study investigates national trends in MI and stroke incidence, treatment, and outcomes among kidney failure patients over two decades.

Observation:

• A retrospective analysis of 16,050 Scottish patients with kidney failure (1996-2016) was conducted.
• Data linkage included hospitalization, prescribing, and mortality records.
• Age-standardized incidence rates for MI and stroke were calculated and stratified by sex.

Findings:

• MI incidence per 100,000 decreased from 4376 to 1835 in men and 3268 to 1369 in women.
• Stroke incidence per 100,000 decreased from 1978 to 799 in men and 2234 to 903 in women.
• Despite reductions, MI incidence remained 4-8 fold higher and stroke incidence 2-4 fold higher in kidney failure patients versus the general population. Cardiovascular death probability within one year of MI or stroke significantly decreased, yet remained substantial.

Implications:

• While incidence and mortality have improved, kidney failure patients still experience disproportionately high rates of MI and stroke.
• Enhanced cardioprotective treatments have contributed to better outcomes.
• Prognosis post-MI and stroke remains poor, highlighting the need for continued research and improved management strategies in this high-risk population.