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Abstract: TH-OR091

Twenty-Year Trends in Mortality Due to Myocardial Infarction and Stroke in Dialysis Patients

Session Information

Category: Dialysis

  • 701 Dialysis: Hemodialysis and Frequent Dialysis

Authors

  • Ocak, Gurbey, University Medical Center Utrecht, Utrecht, Netherlands
  • Noordzij, Marlies, ERA-EDTA Registry, Amsterdam, Netherlands
  • Rookmaaker, Maarten B., University Medical Center Utrecht, Utrecht, Netherlands
  • Verhaar, Marianne C., University Medical Center Utrecht, Utrecht, Netherlands
  • Massy, Ziad, Ambroise Pare University Hospital, Boulogne Billancourt/ Paris , France
  • Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands
  • Jager, Kitty J., ERA-EDTA Registry, Amsterdam, Netherlands
Background

In the last decades, important improvements have been made in the prevention and treatment of myocardial infarction and stroke resulting in reduced mortality rates in the general population. However, it is unknown whether mortality rates of myocardial infarction and stroke have also decreased with time in dialysis patients. The aim of this study was to assess the mortality rates due to myocardial infarction and stroke in a large cohort of dialysis patients as compared with the general population for three time periods.

Methods

We included incident dialysis patients from eleven European countries providing data to the ERA-EDTA Registry who started dialysis between 1994 and 2011 and followed them for three years. The causes of death in dialysis patients were compared with the causes of death in the general population in the same time period. We calculated age- and sex-standardized mortality rate ratios (SMRs) with 95% confidence intervals (CIs) by dividing the mortality rates in dialysis patients by the mortality rates in the general population for three time periods (1994-1999, 2000-2005 and 2006-2011).

Results

Of the 201,918 dialysis patients, 79,327 patients died during follow-up of whom 10.3% died due to myocardial infarction and 6.6% due to stroke. In the general population, 19,058,469 persons died during follow-up of whom 7.4% died due to myocardial infarction and 6.1% due to stroke. Compared with the general population, the SMRs of myocardial infarction for dialysis patients were 11.4 (95% CI 10.8-12.0) between 1994 and 1999, 12.1 (95% CI 11.5-12.8) between 2000 and 2005 and 14.0 (95% CI 13.2-14.8) between 2006 and 2011.
The SMRs of stroke were 11.0 (95% CI 10.3-11.9) between 1994 and 1999, 11.7 (95% CI 10.8-12.6) between 2000 and 2005 and 12.4 (95% CI 11.5-13.3) between 2006 and 2011.

Conclusion

Mortality rate ratios for myocardial infarction and stroke increased with time. Dialysis patients seem to benefit less of improvements made in the prevention and treatment of myocardial infarction and stroke than non-dialysis patients which may be related to the underlying pathophysiological mechanisms of the atherosclerotic disease or to the limited optimal cardiovascular therapeutic strategies.