Abstract: SA-PO828

Relationship between History of Coronary Heart Disease at Dialysis Initiation and Onset of Events Associated with Heart Disease: A Propensity-Matched Analysis of a Prospective Cohort Study

Session Information

Category: Dialysis

  • 606 Dialysis: Epidemiology, Outcomes, Clinical Trials - Cardiovascular

Authors

  • Inaguma, Daijo, Fujita Health University School of Medicine, Toyoake, Aichi, Japan
  • Koide, Shigehisa, Fujita Health University School of Medicine , Aichi, Japan
  • Takahashi, Kazuo, Fujita Health University School of Medicine, Toyoake, Aichi-Ken, Japan
  • Hayashi, Hiroki, Fujita Health University School of Medicine, Toyoake, Aichi-Ken, Japan
  • Hasegawa, Midori, Fujita Health University School of Medicine , Aichi, Japan
  • Yuzawa, Yukio, Fujita Health University School of Medicine , Aichi, Japan
Background

Few studies have reported serial observations during dialysis initiation and maintenance. Therefore, we examined whether the incidence of heart disease events during maintenance dialysis differed between CKD patients with and without a history of coronary heart disease (CHD) at dialysis initiation.

Methods

The subjects were patients in the 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from October 2011 to September 2013. We excluded 9 patients whose outcomes were unknown, as determined by a survey conducted at the end of March 2015. Thus, we enrolled 1,515 subjects into the study. We classified patients into 2 groups according to the history of CHD (i.e., a CHD group and a non-CHD group). Propensity scores (PS) represented the probability of being assigned to a group with or without a history of CHD. Onset of heart disease events and associated mortality and all-cause mortality were compared in PS-matched patients by using the log-rank test for Kaplan-Meier curves. Factors contributing to heart disease events were examined using stepwise multivariate Cox proportional hazards analysis.

Results

There were 254 patients in each group after PS-matching. During observation, heart disease events occurred in 85 patients (33.5%) in the CHD group and 48 (18.9%) patients in the non-CHD group. The incidence was significantly higher in the CHD group (p < 0.001). Heart disease-related death occurred in 27 patients (18.9%) in the CHD group and 12 (10.6%) in the non-CHD group (p = 0.014). All-cause death occurred in 70 patients (27.6%) in the CHD group and 47 (18.5%) in the non-CHD group (p = 0.026).The CHD group was associated with higher incidence of heart disease events (vs. the non-CHD group, HR = 1.75, 95% CI = 1.16-2.64). In addition, comorbidities such as diabetes mellitus (HR = 1.77), low body mass index (HR = 0.92), and low serum high-density lipoprotein cholesterol (/ 10mg/dL, HR = 0.86), were associated with higher incidence of events.

Conclusion

History of CHD at dialysis initiation was associated with a higher incidence of heart disease events and mortality and all-cause mortality.