Are the high mortality rates in dialysis patients mainly due to cardiovascular causes?

Abstract

It is a well-known fact that chronic dialysis patients have a markedly increased mortality compared to the general population. In a recently published analysis of the European Renal Association–European Dialysis and Transplant Association Registry, the mortality rate in incident dialysis patients was 192 per 1000 person-years, while it was only 12.05 in the general population [1]. Despite the emphasis on the importance of accelerated atherosclerosis and cardiovascular death in dialysis patients [2], the excess mortality in them was due to both cardiovascular (39%) and noncardiovascular (51%) causes. The distribution of the causes of death was not different from that in the general population. The standardized mortality ratio for cardiovascular death was 42.9 in dialysis patients compared to 4.9 in the general population. For non-cardiovascular death, these figures were 57.1 and 7.0. This ‘normal’ distribution of mortality causes may lead to a different view on risk factors for mortality in dialysis patients. Also, factors that have been linked to cardiovascular death are often associated with non-cardiovascular mortality. This has been found for C-reactive protein [3], fetuin A [4] and possibly troponin T [5], making it likely that death from various causes is often associated with the presence of an acute-phase reaction.