Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients

Background. Cardiovascular diseases are the most common causes of death amo ng chronic hemodialysis patients, yet the risk factors for these events hav e not been well established. Methods. In this cross-sectional study, we examined the relationship betwee n several traditional cardiovascular disease risk factors and the presence or history of cardiovascular events in 936 hemodialysis patients enrolled i n the baseline phase of the Hemodialysis Study sponsored by the U.S. Nation al Institutes of Health. The adjusted odds ratios for each of the selected risk factors were estimated using a multivariable: logistic regression mode l, controlling for the remaining risk factors, clinical center, and years o n dialysis. Results. Forty percent of the patients had coronary heart disease. Nineteen percent had cerebrovascular disease, and 23% had peripheral vascular disea se. As expected, diabetes and smoking were strongly associated with cardiov ascular diseases. Increasing age was also an important contributor, especia lly in the group less than 55 years and in nondiabetic patients. Black race was associated with a lower risk of cardiovascular diseases than non-black s. Interestingly, neither serum total cholesterol nor predialysis systolic blood pressure was associated with coronary heart disease, cerebrovascular disease, or peripheral vascular disease. Further estimation of the coronary risks in our cohort using the Framingham corollary point score suggests th at traditional risk factors ale inadequate predictors of coronary heart dis ease in hemodialysis patients. Conclusions. Some of the traditional coronary risk factors in the general p opulation appear to be also applicable to the hemodialysis population, whil e other factors did nut correlate with atherosclerotic cardiovascular disea ses in this cross-sectional study. Nontraditional risk factors, including t he uremic milieu and perhaps the hemodialysis procedure itself, are likely to be contributory. Further studies are necessary to define the cardiovascu lar risk factors in order to devise preventive and interventional strategie s For the chronic hemodialysis population.