ABSTRACT
AIMS: To identify factors associated with cardiovascular (CV) disease in hemodialysis. METHODS: Multicenter, prospective, 2-year, observational study in 2,310 incident patients (3,496 patient-years). Multivariate Cox models determined baseline characteristics associated with CV disease. RESULTS: Main factors associated with CV deaths (6.3/100 patient-years) were: high Charlson score (hazard ratio (HR) 3.6; 95% confidence interval (CI) 1.7-7.5 for ≥9 vs. ≤4); low Karnofsky score (KS; HR 2.2; 95% CI 1.5-3.3 for KS ≤50 vs. >70); female gender (HR 1.4; 95% CI 1.1-1.9); catheter access (HR 1.4; 95% CI 1.0-1.9); low (<3.5 g/dl) albumin (HR 2.5; 95% CI 1.8-3.3); ferritin deficiency (HR 1.6; 95% CI 1.2-2.2 for <100 vs. ≥100-500 ng/ml) and low body mass index (BMI; HR 1.9; 95% CI 1.2-3.0 for <20 vs. 20-25). A BMI of ≥30 was a protective factor (HR 0.6; 95% CI 0.4-0.9). CONCLUSIONS: There is a high CV risk, especially in older patients with high comorbidity, low BMI, low albumin or iron deficiency. Catheter access increases the CV death risk.
Subject(s)
Cardiovascular Diseases/epidemiology , Cardiovascular Diseases/mortality , Renal Dialysis/adverse effects , Adult , Body Mass Index , Catheters/adverse effects , Female , Ferritins/analysis , Humans , Kidney Failure, Chronic/complications , Male , Proportional Hazards Models , Prospective Studies , Risk Factors , Serum Albumin/analysis , Spain/epidemiologyABSTRACT
BACKGROUND: Although the association between low haemoglobin levels and mortality is well established in haemodialysis patients, data are conflicting regarding levels >12 g/dl. In addition, divergent results have been reported on the relation between erythropoiesis-stimulating agents (ESAs) and mortality. METHODS: This was a multicentre, observational, prospective, 24-month study, which recruited Spanish incident haemodialysis patients (N = 2310). Univariate and multivariate time-dependent Cox regression models examined the longitudinal association of mortality with haemoglobin and ESA dose; adjustment was made for iron deficiency and other confounders. RESULTS: After adjusting for age, functional status, body mass index, albumin levels, catheter as vascular access, previous history of cardiovascular disease, neoplasia, and ESA dose, mortality decreased with increasing haemoglobin. Adjusted hazard ratios relative to the reference category (11-12 g/dl) and 95% confidence intervals were: 1.36 (1.01-1.86) for
Subject(s)
Anemia/drug therapy , Hematinics/therapeutic use , Hemoglobins/metabolism , Kidney Diseases/mortality , Kidney Diseases/therapy , Renal Dialysis , Adolescent , Adult , Aged , Chronic Disease , Cohort Studies , Dose-Response Relationship, Drug , Follow-Up Studies , Humans , Kidney Diseases/blood , Longitudinal Studies , Middle Aged , Predictive Value of Tests , Proportional Hazards Models , Prospective Studies , Spain , Survival Rate , Treatment Outcome , Young AdultABSTRACT
BACKGROUND: The ANSWER study aims to identify risk factors leading to increased cardiovascular morbidity and mortality in a Spanish incident haemodialysis population. This paper summarizes the baseline characteristics of this population. METHODS: A prospective, observational, one-cohort study, including all consecutive incident haemodialysis patients from 147 Spanish nephrology services, was conducted. Patients were enrolled between October 2003 and September 2004. Sociodemographic, clinical, laboratory and health care characteristics were collected. RESULTS: Baseline characteristics are described for 2341 incident haemodialysis patients [mean (SD) age 65.2 (14.5) years, 63% males]. The main cause of renal failure was diabetic nephropathy (26%). The majority of patients (57%) had a Karnofsky score of 80-100 and 27% were followed up by a nephrologist for