Jh. Brown et al., COMPARATIVE MORTALITY FROM CARDIOVASCULAR-DISEASE IN PATIENTS WITH CHRONIC-RENAL-FAILURE, Nephrology, dialysis, transplantation, 9(8), 1994, pp. 1136-1142
Patients with chronic renal failure show an excess mortality from card
iovascular disease (CVD). Over a 4-year period (1983-1986) we have pro
spectively studied 305 patients (177 men, 128 women) from a geographic
ally constrained population entering a renal replacement therapy (RRT)
programme. The development of new cardiovascular events and patient s
urvival have been documented up to the end of 1990. We have determined
the incidence of CVD amongst the patients compared to the general pop
ulation of the region and assessed the predictive value for future car
diovascular events of risk factors present at the start of RRT. One hu
ndred and fourteen patients experienced a new cardiovascular event. On
e hundred and fifteen patients died, 89 from CVD. Stratification by ag
e and sex identified diabetes, previous coronary heart disease, and ca
rdiomegaly to be significantly associated with an increased risk of a
cardiovascular event, and diabetes, previous coronary heart disease, a
nd accelerated hypertension to be significantly associated with an inc
reased risk of cardiovascular death. Mortality from CVD was 10.1 times
that of the corresponding general population, and was increased 44 ti
mes for patients with diabetes. Duration of RRT did not influence mort
ality rates. This excessive early mortality has significant implicatio
ns for RRT programmes and further research is necessary to identify in
dividuals at risk and the modifiable risk factors that could receive t
argeted interventional therapy.