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Mortalidad cardiovascular y no cardiovascular entre los pacientes que comienzan la diálisis
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
Resumen
Los pacientes que comienzan la diálisis se enfrentan a un riesgo de mortalidad global significativamente mayor. Este mayor riesgo no se debe únicamente a problemas cardiovasculares, sino que también implica elevadas tasas de mortalidad no cardiovascular.
Área de la Ciencia:
- Nefrología Nefrología.
- Salud Pública La salud pública.
- Epidemiología La epidemiología.
Sus antecedentes:
- La mortalidad cardiovascular es la principal causa de muerte en pacientes en diálisis, superando significativamente las tasas de la población general.
- Los pacientes con diálisis experimentan un riesgo de mortalidad 10-20 veces mayor en comparación con la población general.
Objetivo del estudio:
- Determinar si la alta mortalidad en pacientes en diálisis se debe exclusivamente al aumento del riesgo cardiovascular.
- Investigar si la mortalidad no cardiovascular es igualmente elevada en pacientes que inician la diálisis.
Principales métodos:
- Utilizado por la Asociación Renal Europea-Asociación Europea de Diálisis y Trasplante (ERA-EDTA) Datos de registro (1994-2007) para 123.407 pacientes adultos en diálisis.
- Comparó las tasas de mortalidad estratificadas por edad con la población general europea (Eurostat) utilizando métricas estandarizadas de mortalidad cardiovascular y no cardiovascular.
- Se analizó la causa de muerte utilizando los códigos ERA-EDTA y la Clasificación Estadística Internacional de Enfermedades, 10a Revisión (CIE-10).
Principales resultados:
- Los pacientes con diálisis presentaron tasas de mortalidad cardiovascular estandarizada (8,8 veces) y no cardiovascular (8,1 veces) significativamente más altas en comparación con la población general.
- Las muertes no cardiovasculares constituyeron una mayor proporción (51%) de la mortalidad total en pacientes en diálisis que las muertes cardiovasculares (39%).
- El exceso relativo de mortalidad cardiovascular sobre la mortalidad no cardiovascular en pacientes en diálisis fue marginal (1.09).
Conclusiones:
- Los pacientes que inician la diálisis enfrentan un aumento generalizado en el riesgo de mortalidad.
- La elevada mortalidad en pacientes en diálisis no se debe exclusivamente a causas cardiovasculares; la mortalidad no cardiovascular también juega un papel importante.
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