MO832: Survival of Dialysis Patients With Cardiovascular Comorbidity

Abstract

Abstract BACKGROUND AND AIMS Kidney disease is associated with a huge economic burden. High-income countries spend up to 2%–3% of their annual health care budget on end-stage kidney disease. Even if <0.03% of the total population receive such treatment. In 2010, 2.62 million people worldwide received dialysis, and the demand for dialysis is projected to double by 2030. The most common cause of death in patients with CKD is complications from cardiovascular disease. They are the main factor determining the decrease in the effectiveness of renal replacement therapy, especially among young and middle-aged people. Mortality from cardiovascular disease in people with end-stage CKD is 10–30 times higher than in the general population. Purpose of the work: to comparatively study the survival rates in dialysis patients, depending on the presence of cardiovascular diseases. METHOD In our study, we conducted a prospective cohort study of 210 patients (117 men and 93 women) in three different dialysis centers in Uzbekistan. The study lasted 36 months (from January 2018 to December 2020). The average age was 49.2 ± 13.8 years. The main primary diseases were glomerulonephritis (44%), diabetes mellitus (29%) and urolithiasis (7%). The duration of hemodialysis at the time of enrollment of patients in the study ranged from 6 to 172 months. Among the examined dialysis patients, 53% (n = 112) of patients (62 men and 50 women) had CVD and 47% (n = 98) of patients (52 men and 46 women) had no CVD. The main CVDs were arterial hypertension, ischemic heart disease, heart failure and various arrhythmias. Survival was determined by the Kaplan–Meier method. The [95% confidence interval (95% CI)] was determined using the Greenwood method. RESULTS After 36 months of follow-up, 43.8% (n = 92) of all patients died, 56.2% (n = 118) of patients survived (17 of them underwent kidney transplantation). When analyzing the causes of mortality, the main causes of death in dialysis patients were sudden cardiac death, acute respiratory failure, acute cerebrovascular accident, coma and acute bleeding. In dialysis patients with CVD, sudden cardiac death was 67% (n = 42) of all causes of death, while in patients without CVD, it was 57% (n = 17). The average age of the deceased (54.2 ± 1.4) was significantly higher than in patients continuing to receive HD (44.3 ± 1.1). The average duration of hemodialysis in the survivors (34.1 ± 4.7) was higher than in the deceased (27.6 ± 2.8). Upon further analysis of these patients, it was found that among the deceased patients, 70.6% (n = 65) of the patients were patients with cardiovascular diseases, and among the survivors, 54.3% (n = 64) had no cardiovascular diseases. Among those continuing to receive dialysis, there were 32.6% more patients without CVD than among patients with diagnosed CVD. In dialysis patients with CVD who died within 36 months of prospective follow-up, there were 38.7% more deaths than in patients without CVD. The survival rate of patients with CVD was 0.44 (95% CI 0.33–0.51), and in patients without CVD it was 0.65 (95% CI 0.52–0.74). CONCLUSION Our scientific research has shown that >70% of dialysis patients with CKD die due to cardiovascular disease. The main place in the structure of mortality is taken by sudden cardiac death, which is the cause of death in 67% of deceased patients. Cardiovascular comorbidity adversely affects the survival of dialysis patients in Uzbekistan. In dialysis patients without cardiovascular disease in our country, the survival rate is >30% higher than in patients with CVD.