Mortality rate and cardiovascular incidence rate in hemodialysis patients

Results of 2-year follow-up data of the KAREN Study

Abstract

A population-based cohort study of hemodialysis patients (The KAREN Study) has been carried out in the northern part of the main island of Japan since 2003. Follow-up studies were completed on 1, 145 patients 2 years after initial registration. The total observation period was 2, 215 patient-years. There were 189 deaths, 214 cases of congestive heart failure, 29 cases of myocardial infarction, and 107 cases of stroke. Crude mortality was 85 (/1000 patient-years). Incident rates of myocardial infarction and stroke were 13.1 and 48.3, respectively. Cumulative mortality was 16.5%. The difference of mortality between men and women was not significant. The mortality rate in patients with diabetic nephropathy was significantly higher than those in patients with other causes of renal failure (log rank p<<0.01). Multivariate adjusted hazard ratios (HR) were determined by Cox regression analysis. Major risk factors for total mortality in hemodialysis patients were age (HR : (95%CI) : 1.047 (1.033-1.062)), diabetes mellitus (1.416 (1.045-1.919)), the presence of hepatitis C virus antibody (1.581 (1.043-2.395)), low levels of serum albumin 2.430 (1.785-3.308), and elevated serum CRP levels (1.944 (1.442-2.621)). These factors independently contributed to increased mortality regardless of serious comorbid conditions such as myocardial infarction, stroke, and/or malignant disease