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Randomized Controlled Trial
. 2013 Apr 19;8(4):e61155.
doi: 10.1371/journal.pone.0061155. Print 2013.

Should we still focus that much on cardiovascular mortality in end stage renal disease patients? The CONvective TRAnsport STudy

Claire H den Hoedt  1 , Michiel L Bots, Muriel P C Grooteman, Albert H A Mazairac, E Lars Penne, Neelke C van der Weerd, Piet M Ter Wee, Menso J Nubé, Renée Levesque, Peter J Blankestijn, Marinus A van den Dorpel; CONTRAST investigators
Collaborators, Affiliations
Randomized Controlled Trial

Should we still focus that much on cardiovascular mortality in end stage renal disease patients? The CONvective TRAnsport STudy

Claire H den Hoedt et al. PLoS One. .

Abstract

Background: We studied the distribution of causes of death in the CONTRAST cohort and compared the proportion of cardiovascular deaths with other populations to answer the question whether cardiovascular mortality is still the principal cause of death in end stage renal disease. In addition, we compared patients who died from the three most common death causes. Finally, we aimed to study factors related to dialysis withdrawal.

Methods: We used data from CONTRAST, a randomized controlled trial in 714 chronic hemodialysis patients comparing the effects of online hemodiafiltration versus low-flux hemodialysis. Causes of death were adjudicated. The distribution of causes of death was compared to that of the Dutch dialysis registry and of the Dutch general population.

Results: In CONTRAST, 231 patients died on treatment. 32% died from cardiovascular disease, 22% due to infection and 23% because of dialysis withdrawal. These proportions were similar to those in the Dutch dialysis registry and the proportional cardiovascular mortality was similar to that of the Dutch general population. cardiovascular death was more common in patients <60 years. Patients who withdrew were older, had more co-morbidity and a lower mental quality of life at baseline. Patients who withdrew had much co-morbidity. 46% died within 5 days after the last dialysis session.

Conclusions: Although the absolute risk of death is much higher, the proportion of cardiovascular deaths in a prevalent end stage renal disease population is similar to that of the general population. In older hemodialysis patients cardiovascular and non-cardiovascular death risk are equally important. Particularly the registration of dialysis withdrawal deserves attention. These findings may be partly limited to the Dutch population.

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Conflict of interest statement

Competing Interests: CH den Hoedt, ML Bots, NC van der Weerd, EL Penne and AHA Mazairac report receiving no lecture fees, no consulting support, or grant support. MPC Grooteman reports research funded by Fresenius, Gambro and Baxter. PJ Blankestijn reports research funded by Fresenius, Gambro, Roche, Amgen and Novartis, consultant fee and honoraria for lectures from Fresenius, Gambro, Solvay, Medtronic and Novartis. R Lévesque reports research funded by Amgen Canada. PM ter Wee reports research funded by Abbott, Baxter, Gambro, Fresenius and Roche; honoraria for lectures received from Amgen, Roche, Genzyme, Fresenius. MJ Nubé reports research funded by Baxter and Fresenius; honoraria for lectures received from Fresenius and Baxter. MA van den Dorpel reports research funded by Amgen. Furthermore, this does not alter the authors' adherence to all the PLOS ONE policies on sharing data and materials.

Figures

Figure 1
Figure 1. The distribution of death causes across age groups at time of death.
See this image and copyright information in PMC

References

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