Incidence of atherosclerotic arterial occlusive accidents in predialysis and dialysis patients: a multicentric study in the Ile de France district

Background. An abnormally high mortality from atherosclerotic cardiovascula r (CV) accidents has long been reported in patients on maintenance haemodia lysis (HD). However, incidence of atherosclerotic CV accidents had not been so far assessed in predialysis patients. In order to evaluate the respecti ve influence of uraemia and the dialysis procedure, we compared incidence o f atherosclerotic accidents before and after initiation of HD in a large po pulation of patients. Study design, A total of 748 patients (411 male) were included in a retrosp ective study based on anamnestic data of patients living on maintenance hae modialysis in March 1993 in nine dialysis units of the Paris area. Incidenc e of first myocardial infarction (MI) or cerebral infarction (CI) was calcu lated by reference to the number of years of exposure to the risk both befo re and after initiation of HD in the various age groups. Results. Overall, 103 first atherosclerotic accidents were recorded, includ ing 10 CI (7 in males) and 93 MI (68 in males). Of the latter, 39 occurred before and 54 after start of HD, at a mean (+/-SD) age of 62.4+/-9.9 and 63 .7+/-11.1 years respectively. The annual incidence of MI in males was 8.0, 19.5 and 28.3/1000 patient-years, before and 18.8, 21.6 and 29.9 patient-ye ars after start of HD in the age groups 45-54.9, 55-64.9 and greater than o r equal to 65 years respectively, compared to figures of 3.4, 7.5 and 10.4/ 1000 subject-years in the corresponding age groups in the general French po pulation. Conclusion. Incidence of atherosclerotic CV accidents is nearly three times higher in uraemic patients than ill the general population in the same age range in both genders. The fact that incidence and age at onset of first M I was similar in predialysis and in dialysed patients suggests that the ura emic state per se is a main determinant of such accelerated atherosclerosis .