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. 2015 Nov;88(5):1117-25.
doi: 10.1038/ki.2015.117. Epub 2015 Apr 29.

High cardiovascular event rates occur within the first weeks of starting hemodialysis

Kai-Uwe Eckardt  1 , Iain A Gillespie  2 , Florian Kronenberg  3 , Sharon Richards  2 , Peter Stenvinkel  4 , Stefan D Anker  5 , David C Wheeler  6 , Angel L de Francisco  7 , Daniele Marcelli  8 , Marc Froissart  9 , Jürgen Floege  10 ; ARO Steering Committee
Collaborators, Affiliations

High cardiovascular event rates occur within the first weeks of starting hemodialysis

Kai-Uwe Eckardt et al. Kidney Int. 2015 Nov.

Abstract

Early mortality is high in hemodialysis (HD) patients, but little is known about early cardiovascular event (CVE) rates after HD initiation. To study this we analyzed data in the AROii cohort of incident HD patients from over 300 European Fresenius Medical Care dialysis centers. Weekly rates of a composite of CVEs during the first year and monthly rates of the composite and its constituents (coronary artery, cerebrovascular, peripheral arterial, congestive heart failure, and sudden cardiac death) during the first 2 years after HD initiation were assessed. Of 6308 patients that started dialysis within 7 days, 1449 patients experienced 2405 CVEs over the next 2 years. The first-year CVE rate (30.2/100 person-years; 95% CI, 28.7-31.7) greatly exceeded the second-year rate (19.4/100; 95% CI, 18.1-20.8). Composite CVEs were highest during the first week with increased risk compared with the second year, persisting until the fifth month. Except for sudden cardiac death, temporal patterns of rates for all CVE categories were very similar, with highest rates during the first month and a high-risk period extending to 4 months. Higher or lower cumulative weekly dialysis dose, lower blood flow, and lower net ultrafiltration during dialysis were associated with CVE during the high-risk period, but not during the post high-risk period. Thus, the incidence of CVE in the first weeks after HD initiation is much higher than during subsequent periods which raises concerns that HD initiation may trigger CVEs.

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Conflict of interest statement

All authors have completed and submitted the ICMJE Form for Disclosure of Potential Conflicts of Interest. K-UE, FK, PS, SDA, DCW, ALdF, and JF received consultancy fees from Amgen. IAG, MF, and SR are full-time Amgen employees. DM is a full-time FME employee.

Figures

Figure 1
Figure 1
Weekly event rates for the composite cardiovascular events.
Figure 2
Figure 2
Monthly event rates for the composite cardiovascular events and constituent events.
Figure 3
Figure 3
Factors associated with composite cardiovascular events in the high-risk (left) and post high-risk (right) periods. Univariate analysis (actual data shown in Supplementary Table S2 online). BMI, body mass index; CVE, cardiovascular events; HD, hemodialysis.
See this image and copyright information in PMC

Comment in

References

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