Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood

Abstract

To evaluate transitions in causes of death in patients with renal replacement therapy (RRT) since childhood over time, we performed a 10-year extension of the Late Effects of Renal Insufficiency in Children (LERIC) study. The LERIC cohort consisted of all 249 Dutch patients, who were born before 1979 and started RRT <15 years of age between 1972 and 1992. We collected data on mortality and causes of death over the period 2000-10 and compared them with the previously gathered data over the period 1972-99. The median duration of follow-up from the start of RRT was 25.5 (range 0.3-39.0 years). Overall, 97 patients died of whom 34 in 2000-10. The overall mortality rate and mortality rate ratios (MRRs) stabilized over time. The MRR for cardiovascular death decreased from 660 in 1972-89 to 70 in 1990-99 and to 20 in 2000-10. Conversely, the MRR for infectious death showed a U-shape; it decreased from 503 in 1972-89 to 102 in 1990-99 and increased again to 350 in 2000-10. In 2000-10, infections became the most prevalent cause of death (44%). In 2000-10, the cardiovascular mortality had decreased with 91% since 1972-89 [adjusted hazard ratio (HR): 0.09, 95% confidence interval (95% CI): 0.02-0.45, P = 0.003], while infectious mortality had doubled over time, although not significantly (adjusted HR: 2.12, 95% CI: 0.88-5.11, P = 0.09). Over the last decade, we found a substantial shift from cardiovascular disease to infections as the main cause of death at long-term follow-up in patients with chronic kidney disease since childhood and who were born before 1979.