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Vol. 37, No. 2, 2013
Issue release date: March 2013

Determinants of Cardiovascular Risk in Haemodialysis Patients: Post hoc Analyses of the AURORA Study

Schneider A. · Jardine A.G. · Schneider M.P. · Holdaas H. · Holme I. · Fellstroem B.C. · Zannad F. · Schmieder R.E. · on behalf of the AURORA Study Group
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Background: Haemodialysis patients are at high risk for cardiovascular (CV) events. The aim of the current study was to characterise the role of traditional and uraemia-specific CV risk factors in this patient population. Methods: A post hoc analysis of the AURORA trial which enrolled 2,776 haemodialysis patients from 280 centres and had a mean follow-up period of 3.2 years. Determinants of CV endpoints (time to major cardiovascular event (MACE), cardiac event, CV death) were identified by univariate Cox regression analysis. Subsequently, independent determinants were identified by multivariate regression analysis. Results: For the primary endpoint MACE (myocardial infarction, stroke and cardiac death), multivariate analysis revealed that independent determinants were: age (hazard ratio (HR) 1.03 per year), serum phosphate level (HR 1.50 per mmol/l), albumin level (HR 0.94 per g/l), years on haemodialysis (HR 1.03 per year), diabetes mellitus (HR 1.38), preexisting coronary heart disease (HR 1.54) and C-reactive protein (CRP) level (HR 1.14 per mg/l). However, conventional risk factors such as smoking, dyslipidaemia, systolic and diastolic blood pressure and pulse pressure had no significant effect. Conclusions: Although we identify CRP, low albumin, and high phosphorus as risk factors for MACE, lowering CRP did not influence MACE outcomes in our trial. Caution is therefore warranted in implying risk factors being causal in end-stage renal disease.

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  1. Yusuf S, Hawken S, Ounpuu S, et al: Effect of potentially modifiable risk factors associated with myocardial infarction in 52 countries (the INTERHEART study): case-control study. Lancet 2004;364:937–952.
  2. Emberson JR, Whincup PH, Morris RW, Walker M: Re-assessing the contribution of serum total cholesterol, blood pressure and cigarette smoking to the aetiology of coronary heart disease: impact of regression dilution bias. Eur Heart J 2003;24:1719–1726.
  3. Mendelsohn ME, Karas RH: The protective effects of estrogen on the cardiovascular system. N Engl J Med 1999;340:1801–1811.
  4. Hubert HB, Feinleib M, McNamara PM, Castelli WP: Obesity as an independent risk factor for cardiovascular disease: a 26-year follow-up of participants in the Framingham Heart Study. Circulation 1983;67:968–977.
  5. Baxi NS, Jackson JL, Ritter J, Sessums LL: How well do the Framingham risk factors correlate with diagnoses of ischemic heart disease and cerebrovascular disease in a military beneficiary cohort? Mil Med 2011;176:408–413.

    External Resources

  6. Hawranek M, Gasior M, Gierlotka M, et al: Progression of coronary artery atherosclerosis after acute myocardial infarction: an angiographic study. J Invasive Cardiol 2010;22:209–215.

    External Resources

  7. Foley RN, Parfrey PS, Sarnak MJ: Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998;9(suppl):S16–S23.
  8. Fellstrom BC, Jardine AG, Schmieder RE, et al: Rosuvastatin and cardiovascular events in patients undergoing hemodialysis. N Engl J Med 2009;360:1395–1407.
  9. Wanner C, Krane V, Marz W, et al: Atorvastatin in patients with type 2 diabetes mellitus undergoing hemodialysis. N Engl J Med 2005;353:238–248.
  10. Wanner C, Zimmermann J, Schwedler S, Metzger T: Inflammation and cardiovascular risk in dialysis patients. Kidney Int Suppl 2002;80:99–102.
  11. Beddhu S, Kaysen GA, Yan G, et al: Association of serum albumin and atherosclerosis in chronic hemodialysis patients. Am J Kidney Dis 2002;40:721–727.
  12. Block GA, Hulbert-Shearon TE, Levin NW, Port FK: Association of serum phosphorus and calcium × phosphate product with mortality risk in chronic hemodialysis patients: a national study. Am J Kidney Dis 1998;31:607–617.
  13. Ganesh SK, Stack AG, Levin NW, Hulbert-Shearon T, Port FK: Association of elevated serum PO4, Ca × PO4 product, and parathyroid hormone with cardiac mortality risk in chronic hemodialysis patients. J Am Soc Nephrol 2001;12:2131–2138.
  14. Drechsler C, Pilz S, Obermayer-Pietsch B, et al: Vitamin D deficiency is associated with sudden cardiac death, combined cardiovascular events, and mortality in haemodialysis patients. Eur Heart J 2010;31:2253–2261.
  15. Zimmermann J, Herrlinger S, Pruy A, Metzger T, Wanner C: Inflammation enhances cardiovascular risk and mortality in hemodialysis patients. Kidney Int 1999;55:648–658.
  16. Holdaas H, Holme I, Schmieder RE, et al: Rosuvastatin in diabetic hemodialysis patients. J Am Soc Nephrol 2011;22:1335–1341.
  17. Baigent C, Landray MJ, Reith C, et al: The effects of lowering LDL cholesterol with simvastatin plus ezetimibe in patients with chronic kidney disease (Study of Heart and Renal Protection): a randomised placebo-controlled trial. Lancet 2011;377:2181–2192.
  18. Cheung AK, Sarnak MJ, Yan G, et al: Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000;58:353–362.
  19. Kalantar-Zadeh K, Block G, Humphreys MH, Kopple JD: Reverse epidemiology of cardiovascular risk factors in maintenance dialysis patients. Kidney Int 2003;63:793–808.
  20. Roberts MA, Polkinghorne KR, McDonald SP, Ierino FL: Secular trends in cardiovascular mortality rates of patients receiving dialysis compared with the general population. Am J Kidney Dis 2011;58:64–72.
  21. Kessler M, Zannad F, Lehert P, et al: Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the fosinopril in dialysis study. Nephrol Dial Transplant 2007;22:3573–3579.
  22. Shuto E, Taketani Y, Tanaka R, et al: Dietary phosphorus acutely impairs endothelial function. J Am Soc Nephrol 2009;20:1504–1512.
  23. Blacher J, Guerin AP, Pannier B, Marchais SJ, Safar ME, London GM: Impact of aortic stiffness on survival in end-stage renal disease. Circulation 1999;99:2434–2439.
  24. London GM, Marchais SJ, Guerin AP, Metivier F: Arteriosclerosis, vascular calcifications and cardiovascular disease in uremia. Curr Opin Nephrol Hypertens 2005;14:525–531.
  25. Kovesdy CP, Kalantar-Zadeh K: Review article: Biomarkers of clinical outcomes in advanced chronic kidney disease. Nephrology (Carlton) 2009;14:408–415.
  26. Wanner C, Metzger T: C-reactive protein a marker for all-cause and cardiovascular mortality in haemodialysis patients. Nephrol Dial Transplant 2002;17(suppl 8):29–32, 39–40.
  27. Kato A, Takita T, Furuhashi M, Maruyama Y, Hishida A: Comparison of serum albumin, C-reactive protein and carotid atherosclerosis as predictors of 10-year mortality in hemodialysis patients. Hemodial Int 2010;14:226–232.
  28. Snaedal S, Heimburger O, Qureshi AR, et al: Comorbidity and acute clinical events as determinants of C-reactive protein variation in hemodialysis patients: implications for patient survival. Am J Kidney Dis 2009;53:1024–1033.
  29. Pecoits-Filho R, Lindholm B, Stenvinkel P: The malnutrition, inflammation, and atherosclerosis (MIA) syndrome – the heart of the matter. Nephrol Dial Transplant 2002;17(suppl 11):28–31.
  30. De Mutsert R, Grootendorst DC, Axelsson J, Boeschoten EW, Krediet RT, Dekker FW: Excess mortality due to interaction between protein-energy wasting, inflammation and cardiovascular disease in chronic dialysis patients. Nephrol Dial Transplant 2008;23:2957–2964.
  31. Cano NJ, Fouque D, Roth H, et al: Intradialytic parenteral nutrition does not improve survival in malnourished hemodialysis patients: a 2-year multicenter, prospective, randomized study. J Am Soc Nephrol 2007;18:2583–2591.
  32. Recio-Mayoral A, Banerjee D, Streather C, Kaski JC: Endothelial dysfunction, inflammation and atherosclerosis in chronic kidney disease – a cross-sectional study of predialysis, dialysis and kidney-transplantation patients. Atherosclerosis 2011;216:446–451.
  33. Hung AM, Ellis CD, Shintani A, Booker C, Ikizler TA: IL-1β receptor antagonist reduces inflammation in hemodialysis patients. J Am Soc Nephrol 2011;22:437–442.

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