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Abstract: FR-PO826

Polyvascular Disease and Cardiovascular Risk in Hemodialysis Patients: Ten-Year Outcomes of the Q-Cohort Study

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Tanaka, Shigeru, Fukuoka Dental College, Fukuoka, Japan
  • Nakano, Toshiaki, Kyushu University, Fukuoka, Japan
  • Hiyamuta, Hiroto, Kyushu University, Fukuoka, Japan
  • Taniguchi, Masatomo, Fukuoka Renal Clinic, Fukuoka, Japan
  • Tokumoto, Masanori, Department of Internal Medicine, Fukuoka Dental College, Sawara-ku, FUKUOKA, Japan
  • Ooboshi, Hiroaki, Fukuoka Dental College, Fukuoka, Japan
  • Tsuruya, Kazuhiko, Nara Medical University, Kashihara, Japan
  • Kitazono, Takanari, Department of Medicine and Clinical Science, Fukuoka, Japan
Background

Patients with polyvascular disease (PVD), which indicates co-existing arteriosclerotic disease on multiple vascular beds, have been identified to be a high-risk group of recurrent ischemic events in a community setting. However, the impact of PVD on the risk of cardiovascular events has not been evaluated previously in a hemodialysis population.

Methods

A total of 3,504 hemodialysis patients were prospectively followed for 10 years. PVD were defined as prior cardiovascular disease plus co-existing vascular diseases in one or more vascular beds. We examined the relationship between PVD and the occurrence of composite end point of ischemic events, including cardiovascular death, non-fatal coronary artery disease, stroke, and critical limb ischemia.

Results

The proportion of participants with PVD was 5.7% (n=200) at baseline. During follow-up period (median: 106.6 months, interquartile range: 50.1–121.8 months), 1,316 patients experienced at least 1 or more events of cardiovascular death (n=620), non-fatal coronary artery disease (n=456), stroke (n=524) or critical limb ischemia (n=257). In multivariable analysis, PVD was the most powerful predictor for ischemic events exceeding the contribution of presumed risk factors such as diabetes, aging and hypertension. Compared to the group without injured vascular beds, the risk of the events significantly elevated with the increase in the number of injured vascular beds (hazard ratio [HR] 1.71, 95% confidence interval [CI] 1.52–1.92 in the group of single vascular bed lesions, and HR 2.16, 95% CI 1.78–2.67 in the group of polyvascular bed lesions).

Conclusion

This study clearly demonstrates that PVD is the most powerful predictor for future incidences of ischemic events in hemodialysis patients.