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Cardiovascular Mortality Decreasing in the Dialysis Population

Mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased over time among patients receiving dialysis, including compared with the general population, a new study finds.

Among 220,467 patients initiating dialysis in 11 European countries, 83,912 patients died, including 7662 (9.1%) from myocardial infarction, 5030 (6.0%) from stroke, and 435 (0.5%) from pulmonary embolism. From 1998 to 2015, the crude mortality rate (in deaths per 1000 person-years) for myocardial infarction decreased from 23.7 to 12.2, stroke from 14.8 to 8.9, and pulmonary embolism from 1.4 to 0.7 in the dialysis population, Gurbey Ocak, MD, PhD, of Sint Antonius Hospital, Nieuwegein, the Netherlands, and colleagues reported in JAMA Network Open.

The investigators compared cardiovascular mortality rates in the dialysis population to the general population using age- and sex-standardized mortality rate ratios (SMRs). Over the periods 1998-2003 to 2010-2015, the SMRs (in deaths per 1000 person-years) from myocardial infarction decreased from 8.1 to 6.8, stroke from 7.3 to 5.8, and pulmonary embolism from 8.7 to 5.5.

 

“This improvement may be due to better predialysis and dialysis care,” Dr Ocak’s team suggested.

 

Therapies that are effective in the general population may not be beneficial for patients receiving dialysis, the investigators noted.

 

“Therefore, in our opinion, future studies should focus on tailored therapy for patients receiving dialysis rather than on implementing prevention and treatment schemes that are recommended for the general population.”

 

The study is limited by a lack of information on baseline estimated glomerular filtration rate, comorbidities, laboratory data, and medication use.

 

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