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      Combined assessment of cardiac systolic dysfunction and coronary atherosclerosis used to predict future cardiac deaths after starting hemodialysis.

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          Abstract

          Identification of end-stage renal disease (ESRD) patients at high risk for cardiac events is important for clinical dialysis management. The present study determined whether the combination of cardiac function and coronary atherosclerosis could predict future cardiac events after starting renal replacement therapy (RRT).

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          Poor long-term survival after acute myocardial infarction among patients on long-term dialysis.

          Joseph Collins, Jianjie Ma, C Herzog (1998)
          Cardiovascular disease is common in patients on long-term dialysis, and it accounts for 44 percent of overall mortality in this group. We undertook a study to assess long-term survival after acute myocardial infarction among patients in the United States who were receiving long-term dialysis. Patients on dialysis who were hospitalized during the period from 1977 to 1995 for a first myocardial infarction after the initiation of renal-replacement therapy were retrospectively identified from the U.S. Renal Data System data base. Overall mortality and mortality from cardiac causes (including all in-hospital deaths) were estimated by the life-table method. The effect of independent predictors on survival was examined in a Cox regression model with adjustment for existing illnesses. The overall mortality (+/-SE) after acute myocardial infarction among 34,189 patients on long-term dialysis was 59.3+/-0.3 percent at one year, 73.0+/-0.3 percent at two years, and 89.9+/-0.2 percent at five years. The mortality from cardiac causes was 40.8+/-0.3 percent at one year, 51.8+/-0.3 percent at two years, and 70.2+/-0.4 percent at five years. Patients who were older or had diabetes had higher mortality than patients without these characteristics. Adverse outcomes occurred even in patients who had acute myocardial infarction in 1990 through 1995. Also, the mortality rate after myocardial infarction was considerably higher for patients on long-term dialysis than for renal-transplant recipients. Patients on dialysis who have acute myocardial infarction have high mortality from cardiac causes and poor long-term survival.
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            Congestive heart failure in subjects with normal versus reduced left ventricular ejection fraction

            Ramachandran S Vasan, Martin Larson, ScD, Emelia Benjamin … (1999)
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              How to adjust for comorbidity in survival studies in ESRD patients: a comparison of different indices.

              Gerda van Wezel-Meijler, Patrick Bossuyt, J Korevaar … (2002)
              Many patients with end-stage renal disease (ESRD) have additional comorbid conditions. Differences in the presence and severity of these comorbid conditions can bias comparisons between treatment groups. Adjustment for prognostic factors can statistically counterbalance these differences. For this purpose, appropriate weighting of comorbid conditions is necessary. We evaluated three existing methods to score comorbidity in patients with ESRD and compared their ability to predict survival: the Khan, Davies, and Charlson indices. In addition, these three indices were compared with a new index that explicitly incorporates the severity grading of a number of comorbid diseases. In a large Dutch prospective multicenter study (Netherlands Co-operative Study on the Adequacy of Dialysis-2), new patients with ESRD were included. Comorbidity was assessed at the start of dialysis therapy. Patient data were randomly allocated to a modeling or testing set. The new index was developed in the modeling set. All indices were evaluated in the testing set. We obtained data for 1,205 patients. Of the three existing indices, the Charlson index had the best discriminating features, with a concordance c statistic of 0.71. The addition of severity grading of several comorbid conditions did not improve discrimination. After combining the comorbidity indices with age, all c statistics improved. These final values ranged from 0.72 to 0.75. We conclude that the Khan, Davies, and Charlson scores are appropriate for expressing the prognostic impact of comorbidity on mortality risk in patients with ESRD provided sufficient adjustment for age is performed. Adding the severity grading of several comorbid conditions will not lead to improved prognostic power. Copyright 2002 by the National Kidney Foundation, Inc.
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                Author and article information

                Journal
                Journal ID (iso-abbrev): Am. J. Nephrol.
                Title: American journal of nephrology
                Publisher: S. Karger AG
                ISSN: 0250-8095
                ISSN (Print): 0250-8095
                Publication date (Electronic): October 30 2003
                Volume: 23
                Issue: 6
                Affiliations
                [1 ] Division of Dialysis and Nephrology, Nissan Tamagawa Hospital, Tokyo, Japan. joki@oha.toho-u.ac.jp
                Article
                Publisher Item ID: 74538
                DOI: 10.1159/000074538
                PubMed ID: 14583665
                SO-VID: 37dc3d1f-c981-489c-9794-14fda1c087fa
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