Abstract
Cardiovascular Mortality in Hemodialysis Patients: Clinical and Epidemiological AnalysisCardiovascular diseases are the leading cause of death in hemodialysis (HD) patients. The annual cardiovascular mortality rate in these patients is 9%, with left ventricular (LV) hypertrophy, ischemic heart disease and heart failure being the most prevalent causes of death. The aim of this study was to determine the cardiovascular mortality rate and estimate the influence of risk factors on cardiovascular mortality in HD patients. A total of 115 patients undergoing HD for at least 6 months were investigated. Initially a cross-sectional study was performed, followed by a two-year follow-up study. Beside the standard biochemical parameters, C-reactive protein (CRP), homocysteine, cardiac troponins (cTn) and the echocardiographic parameters of LV morphology and function (LV mass index, LV fractional shortening, LV ejection fraction) were determined. Results were analyzed using Cox regression analysis, Kaplan-Meier and Log-Rank tests. The average one-year cardiovascular mortality rate was 8.51%. Multivariate Cox regression analysis identified increased CRP, cTn T and I, and LV mass index as independent risk factors for cardiovascular mortality. Patients with cTnT > 0.10 ng/mL and CRP > 10 mg/L had significantly higher cardiovascular mortality risk (p < 0.01) than patients with cTnT > 0.10 ng/mL and CRP ≤ 10 mg/L and those with cTnT ≤ 0.10 ng/mL and CRP ≤ 10 mg/L (p < 0.01). HD patients with high cTnT and CRP have a higher cardiovascular mortality risk.
Highlights
Cardiovascular diseases are the leading cause of death in hemodialysis (HD) patients
HD patients are at high risk of sudden cardiac death due to left ventricular hypertrophy (LVH), disturbed coronary circulation, decreased coronary reserve, increased sympathetic activity and angiotensin II plasma concentration and fast electrolyte changes during HD [6,7,8,9]
Identifying patients at high risk for cardiovascular complications and cardiovascular mortality is based on measuring serum C-reactive protein (CRP), homocysteine, cardiac troponins T and I, and determining relevant echocardiographic markers (LV mass index – LVMi, end-diastolic left ventricular (LV) volume index – iEDV and LV ejection fraction – Left ventricular ejection fraction (LVEF)) [6,7,8,9]
Summary
Cardiovascular diseases are the leading cause of death in hemodialysis (HD) patients. The high incidence and prevalence of cardiovascular diseases in HD patients are related to high blood pressure, disturbed lipid metabolism, oxidative stress, microinflammation, hyperhomocysteinemia, anemia, secondary hyperparathyroidism and vascular shunt flow [1,2,3,4,5]. The annual cardiovascular mortality rate in these patients is 9%, with left ventricular hypertrophy (LVH), ischemic heart disease and congestive heart failure being the most prevalent causes [5]. HD patients are at high risk of sudden cardiac death due to LVH, disturbed coronary circulation, decreased coronary reserve, increased sympathetic activity and angiotensin II plasma concentration and fast electrolyte changes during HD (potassium, calcium, magnesium) [6,7,8,9]. Identifying patients at high risk for cardiovascular complications and cardiovascular mortality is based on measuring serum C-reactive protein (CRP), homocysteine, cardiac troponins (cTn) T and I, and determining relevant echocardiographic markers (LV mass index – LVMi, end-diastolic LV volume index – iEDV and LV ejection fraction – LVEF) [6,7,8,9]
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