Dialysis Patient CAD Burden Rising, Mortality Declining
Coronary artery disease (CAD) is on the rise among U.S. dialysis patients, but mortality rates are declining, new findings show.
Austin G. Stack, MD, of the University of Limerick in Limerick, Ireland, and colleagues analyzed data from 823,753 incident dialysis patients and found that the annual prevalence of CAD at dialysis initiation increased significantly from 23.7% in 1995 to 27.6% in 2004, according to a report in the American Journal of Nephrology (2013;38:66-74).
In addition, from 1995 to 2004, the prevalence increased significantly from 28.7% to 32.4% among whites and from 14.3% to 17.5% among blacks, and it increased significantly from 25.2% to 29.7% among men and from 22.1% to 25.1% among women.
Death rates (per 1,000 person-years) among men rose from 352 in 1995 to 379 in 1997 and then decreased to 248 in 2004. The rates among women rose increased from 366 in 1995 to 396 in 1999 and then declined to 357 in 2004.
As to what would explain falling mortality rates despite increasing CAD burden, Dr. Stack's group observed: “Such trends may reflect improved effectiveness of cardiovascular surveillance and treatments in the general population prior to dialysis as well as advancements in clinical care delivery after initiation.”