Acute myocardial infarction (AMI) is more likely among patients on hemeodialysis than in those on peritoneal dialysis (PD), a new study found.
Among 86,215 patients initiating maintenance dialysis during 1998 to 2010 in Taiwan’s National Health Insurance Research Database, investigators identified 5513 pairs of HD and PD patients matched by age, sex, year of dialysis initiation, and 20 relevant comorbidities such as diabetes, hypertension, heart failure, and coronary artery disease. Patients with a prior AMI, switch in dialysis modality, kidney transplant, or malignancy were excluded.
AMI incidence was significantly higher among HD than PD patients: 9.71 vs 8.35 per 1000 patient-years, respectively, Yu-Tzu Chang, MD, of National Cheng Kung University Hospital in Taiwan, and colleagues reported in Atherosclerosis. HD patients had a 30% greater risk for AMI. Furthermore, the cumulative incidence rate for AMI increased significantly and substantially after 4 years from the start of dialysis: 0.09 vs 0.05, respectively. Analyses of the entire unmatched cohort and important subgroups showed similar trends.
These results differ from some previous research showing no differences in AMI risk between HD and PD patients. But these studies often examined a composite cardiovascular end point or excluded heart failure patients, the investigators pointed out.
According to Dr Chang’s team, “chronic myocardial ischemia induced by serial changes in hemodynamic status and microvascular changes during hemodialysis might ultimately increase the risk of cardiovascular events, including AMI.”
“Preventive and surveillance programs for AMI should be customized specifically for dialysis populations with different dialysis modalities, vintage, and concomitant risk factors for AMI,” they recommended.
Sun C-Y, Li C-Y, Sung J-M, Cheng Y-Y, et al. A comparison of the risk of acute myocardial infarction in patients receiving hemodialysis and peritoneal dialysis: A population-based, propensity score-matched cohort study. Atheroscl. doi: 10.1016/j.atherosclerosis.2020.05.010