Cardiovascular event rates among patients on dialysis vary by the cause of their end-stage renal disease (ESRD), with the highest rate occurring among those with ESRD attributable to diabetic nephropathy (DN), according to a new study.

“Although we cannot determine the underlying reasons for these differences, our data strongly support the presence of independent disease-specific influences,” investigators concluded in a paper published in the European Heart Journal.

In a study of 656,168 Medicare patients who initiated dialysis from 1997 to 2014, Michelle M. O’Shaughnessy, MD, of Stanford University School of Medicine in Palo Alto, California, and collaborators examined the risk for a first composite cardiovascular event (myocardial infarction, ischemic stroke, or cardiovascular or cerebrovascular death) starting at day 91 after dialysis initiation.

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Patients with DN-related ESRD had a cardiovascular event rate of 14.3 events per 100 person-years. Patients with ESRD due to IgA nephropathy had the lowest rate: 3.36 events per 100 person years. Compared with patients who had IgA nephropathy, those with DN had a nearly 3-fold increased risk of a cardiovascular event in adjusted analyses.

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Patients with ESRD attributable to lupus nephritis, membranous nephropathy, focal segmental glomerulosclerosis, membranoproliferative glomerulonephritis, vasculitis, and autosomal dominant polycystic kidney disease had a 1.86-, 1.67-, 1.65-, 1.55-, 1.55- and 1.29-fold increased risk, respectively.

Determine the underlying reasons for why cardiovascular event rates vary by ESRD cause “might provide new insights in cardiovascular disease mechanisms as well as inform future drug development and clinical trial design,” they concluded.


O’Shaughnessy MM, Liu S, Montez-Rath ME, et al. Cause of kidney disease and cardiovascular events in a national cohort of US patients with end-stage renal disease on dialysis: a retrospective analysis.  Eur Heart J. 2018; published online ahead of print.