JAMA: Patients starting dialysis have increased mortality risk, not from CV causes

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Compared to the general population, patients starting dialysis have an increased risk of death that is not attributable to a higher rate of death from cardiovascular causes, as previously thought, according to a study in the Oct. 28 issue of the Journal of the American Medical Association.

Several studies have shown that cardiovascular disease accounts for 40 to 50 percent of deaths in patients with end-stage kidney disease, according to the background information in the article. “It is believed that the life span of patients receiving dialysis is reduced mainly as a consequence of premature cardiovascular death,” the authors wrote.

Dinanda J. de Jager, MSc, of the Leiden University Medical Center in Leiden, the Netherlands, and colleagues estimated cardiovascular and non-cardiovascular rates of death in a large group of European patients receiving dialysis (123,407 patients) and compared these estimates with mortality data from the general European population, using data from between January 1994 and January 2007.

The researchers found that among the patients receiving dialysis, non-cardiovascular death was the most prevalent cause of death (50.8 percent), and 39.1 percent died because of cardiovascular disease. The most common causes of non-cardiovascular death were infections and malignancies.

In the general population, about 10.2 million people (58.4 percent) died from non-cardiovascular causes, about seven million people (40.4 percent) from cardiovascular causes and approximately 200,000 (1.2 percent) from unknown causes, de Jager and colleagues reported.

Analysis indicated that the overall all-cause mortality rate was higher in patients starting dialysis than in the general population, according to the researchers.

“In particular, non-cardiovascular mortality rates were higher than cardiovascular mortality rates in patients starting dialysis,” the authors wrote. “These results suggest that excess mortality in patients receiving dialysis is not specifically the result of increased cardiovascular deaths.”

“In summary, the present study shows that cardiovascular and non-cardiovascular mortality are equally increased during the first three years of dialysis, compared with the general population,” de Jager and colleagues concluded. “This implies that the importance of non-cardiovascular mortality in patients receiving dialysis has generally been underestimated. Therefore, research should focus more on methods to prevent non-cardiovascular mortality.”