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. 2022 May;27(5):430-440.
doi: 10.1111/nep.14020. Epub 2022 Jan 19.

Epidemiology of cardiovascular death in kidney failure: An Australian and New Zealand cohort study using data linkage

Victor Khou  1 , Nicole L De La Mata  1 , Patrick J Kelly  1 , Philip Masson  2 , Emma O'Lone  1 , Rachael L Morton  3 , Angela C Webster  1   3   4
Affiliations

Epidemiology of cardiovascular death in kidney failure: An Australian and New Zealand cohort study using data linkage

Victor Khou et al. Nephrology (Carlton). 2022 May.

Abstract

Aim: Cardiovascular mortality risk evolves over the lifespan of kidney failure (KF), as patients develop comorbid disease and transition between treatment modalities. Absolute cardiovascular death rates would help inform clinical practice and health-care provision, but are not well understood across a continuum of dialysis and transplant states. We aimed to characterize cardiovascular death across the natural history of KF using a lifespan approach.

Methods: We performed a population-based cohort study of incident patients commencing kidney replacement therapy in Australia and New Zealand. Cardiovascular deaths were identified using data linkage to national death registers. We estimated the probability of death and kidney transplant using multi-state models, and calculated rates of graft failure and cardiovascular death across demographic factors and comorbidities.

Results: Among 60 823 incident patients followed over 381 874 person-years, 25% (8492) of deaths were from cardiovascular disease. At 15 years from treatment initiation, patients had a 15.2% probability of cardiovascular death without being transplanted, but only 2.3% probability of cardiovascular death post-transplant. Females had a 3% lower probability of cardiovascular death at 15 years (15.3% vs. 18.6%) but 4% higher probability of non-cardiovascular death (54.5% vs. 50.8%). Within the first year of dialysis, cardiovascular mortality peaked in the second month and showed little improvement across treatment era.

Conclusion: Despite improvements over time, cardiovascular death remains common in KF, particularly among the dialysis population and in the first few months of treatment. Multi-state models can provide absolute measures of cardiovascular mortality across both dialysis and transplant states.

Keywords: cardiovascular disease; chronic; dialysis; kidney failure; mortality.

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Conflict of interest statement

The authors declared no conflicts of interest. The results presented in this paper have not been published previously in whole or part, except in abstract format.

Figures

FIGURE 1
FIGURE 1
Multi‐state model demonstrating probability of cardiovascular and non‐cardiovascular death with or without transplant, over time from kidney replacement therapy
FIGURE 2
FIGURE 2
Mortality rates from cardiovascular death stratified by sex, within (A) 12 months and 15 years after dialysis initiation, (B) 12 months and 15 years after kidney transplant
FIGURE 3
FIGURE 3
Mortality rates from cardiovascular death stratified by calendar year period of kidney replacement therapy, within (A) 12 months and 15 years after dialysis initiation, (B) 12 months and 15 years after kidney transplant
FIGURE 4
FIGURE 4
Rates of (A) graft failure, and (B) composite graft failure and death post‐transplant, stratified by sex, time from transplant and pre‐existing cardiovascular disease
See this image and copyright information in PMC

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