Abstract
Importance: Over the past decades, improvements in the prevention and treatment of myocardial infarction, stroke and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. It is unknown whether dialysis patients have also benefited from these improvements.
Objective: The aim of this study was to assess the mortality rates due to myocardial infarction, stroke and pulmonary embolism in a large cohort of European dialysis patients compared with the general population. From a clinical perspective, it is important to know whether advances in preventive and clinical treatment strategies have also resulted in improved outcomes among dialysis patients.
Design, Setting, and Participants: We included patients who started dialysis between 1998 and 2015 from eleven European countries providing data to the European Renal Association (ERA) Registry and followed them for three years.
Exposures: Start of dialysis.
Main Outcomes and Measures: We calculated age- and sex-standardized mortality rate ratios (SMRs) with 95% confidence intervals (CIs) by dividing the mortality rates in dialysis patients by the mortality rates in the general population for three equal time periods (1998-2003, 2004-2009 and 2010-2015).
Results: In total, 220,467 dialysis patients were included in the study. Their median age was 68 years and 37.2% were female. Their median age was 68 years and 37.2% were female. During follow-up 83,912 patients died, of whom 9.1% due to myocardial infarction, 6.0% due to stroke and 0.5% due to pulmonary embolism. Between the periods 1998-2003 and 2010-2015, the SMR of myocardial infarction decreased from 8.1 (95% CI 7.8-8.3) to 6.8 (95% CI 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI 7.0-7.6) to 5.8 (95% CI 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI 7.6-10.1) to 5.5 (95% CI 4.5-6.6).
Conclusions and Relevance: In this cohort study of dialysis patients, mortality rates for myocardial infarction, stroke and pulmonary embolism decreased more over time than in the general population.
Objective: The aim of this study was to assess the mortality rates due to myocardial infarction, stroke and pulmonary embolism in a large cohort of European dialysis patients compared with the general population. From a clinical perspective, it is important to know whether advances in preventive and clinical treatment strategies have also resulted in improved outcomes among dialysis patients.
Design, Setting, and Participants: We included patients who started dialysis between 1998 and 2015 from eleven European countries providing data to the European Renal Association (ERA) Registry and followed them for three years.
Exposures: Start of dialysis.
Main Outcomes and Measures: We calculated age- and sex-standardized mortality rate ratios (SMRs) with 95% confidence intervals (CIs) by dividing the mortality rates in dialysis patients by the mortality rates in the general population for three equal time periods (1998-2003, 2004-2009 and 2010-2015).
Results: In total, 220,467 dialysis patients were included in the study. Their median age was 68 years and 37.2% were female. Their median age was 68 years and 37.2% were female. During follow-up 83,912 patients died, of whom 9.1% due to myocardial infarction, 6.0% due to stroke and 0.5% due to pulmonary embolism. Between the periods 1998-2003 and 2010-2015, the SMR of myocardial infarction decreased from 8.1 (95% CI 7.8-8.3) to 6.8 (95% CI 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI 7.0-7.6) to 5.8 (95% CI 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI 7.6-10.1) to 5.5 (95% CI 4.5-6.6).
Conclusions and Relevance: In this cohort study of dialysis patients, mortality rates for myocardial infarction, stroke and pulmonary embolism decreased more over time than in the general population.
| Original language | English |
|---|---|
| Article number | e227624 |
| Number of pages | 14 |
| Journal | JAMA Network Open |
| Volume | 5 |
| Issue number | 4 |
| DOIs | |
| Publication status | Published - 18 Apr 2022 |
Keywords
- dialysis
- mortality
- bleeding
- myocardial infarction
- stroke
ASJC Scopus subject areas
- General Medicine