Traditional risk factors, such as lipid disturbances, do not predict atherosclerotic cardiovascular events in maintenance hemodialysis (HD) patients, new study findings in Nephrology Dialysis Transplantation confirm.
Although heart failure and sudden death are more common in these patients, atherosclerotic events are likewise important. Marit D. Solbu, PhD, of the University of Glasgow in the UK, and colleagues studied predictors of atherosclerotic cardiovascular events in post hoc analyses of the AURORA (A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events) trial. All deaths were readjudicated.
Over 3.2 years of follow-up, 506 patients from 25 countries (mean age 67 years; dialysis vintage 3.5 years) experienced an atherosclerotic outcome, including non-fatal myocardial infarction, fatal coronary heart disease, non-fatal and fatal non-hemorrhagic stroke, coronary revascularization procedures, and death from peripheral arterial disease. A model based on stepwise Cox regression analysis determined that certain factors, particularly markers of inflammation and oxidative stress, significantly predicted atherosclerotic cardiovascular events: age, male sex, diabetes, history of cardiovascular disease, weekly dialysis duration, baseline albumin levels, high-sensitivity C-reactive protein, and oxidized low-density lipoprotein (LDL) cholesterol. LDL cholesterol and rosuvastatin use did not emerge as predictive.
“One may speculate that ‘traditional’ atherosclerosis associated with traditional risk factors becomes less common, whereas vascular calcification, not readily accessible for established preventive measures, becomes increasingly important with increasing time on HD,” Dr Solbu and her colleagues wrote. They speculated that oxidative LDL cholesterol might be atherogenic or proinflammatory or a marker of these processes. Future research on these markers as possible targets for intervention are warranted.
Solbu MD, Mjøen G, Mark PB, et al. Predictors of atherosclerotic events in patients on haemodialysis: post hoc analyses from the AURORA study. Nephrol Dial Transplant 2018;33:102–112. doi: 10.1093/ndt/gfw360