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Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis

Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis


Title: Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis
Author: Ocak, Gurbey
Boenink, Rianne
Noordzij, Marlies
Bos, Willem Jan W.
Vikse, Bjorn E.
Cases, Aleix
Kerschbaum, Julia
Helve, Jaakko
Nordio, Maurizio
Arici, Mustafa
... 13 more authors Show all authors
Date: 2022-04-18
Language: English
Scope: E227624
Department: Other departments
Faculty of Medicine
Office of Division of Clinical Services I
Series: JAMA network open; 5(4)
ISSN: 2574-3805
DOI: https://doi.org/10.1001/jamanetworkopen.2022.7624
Subject: Adult; Aged; Cohort Studies; Female; Humans; Male; Myocardial Infarction/epidemiology; Pulmonary Embolism; Renal Dialysis; Stroke/epidemiology; Medicine (all)
URI: https://hdl.handle.net/20.500.11815/3869

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Citation:

Ocak , G , Boenink , R , Noordzij , M , Bos , W J W , Vikse , B E , Cases , A , Kerschbaum , J , Helve , J , Nordio , M , Arici , M , Mercadal , L , Wanner , C , Palsson , R , Hommel , K , De Meester , J , Kostopoulou , M , Santamaria , R , Rodrigo , E , Rydell , H , Bell , S , Massy , Z A , Jager , K J & Kramer , A 2022 , ' Trends in Mortality Due to Myocardial Infarction, Stroke, and Pulmonary Embolism in Patients Receiving Dialysis ' , JAMA network open , vol. 5 , no. 4 , pp. E227624 . https://doi.org/10.1001/jamanetworkopen.2022.7624

Abstract:

Importance: During the past decades, improvements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism have led to a decline in cardiovascular mortality in the general population. However, it is unknown whether patients receiving dialysis have also benefited from these improvements. Objective: To assess the mortality rates for myocardial infarction, stroke, and pulmonary embolism in a large cohort of European patients receiving dialysis compared with the general population. Design, Setting, and Participants: In this cohort study, adult patients who started dialysis between 1998 and 2015 from 11 European countries providing data to the European Renal Association Registry were and followed up for 3 years. Data were analyzed from September 2020 to February 2022. Exposures: Start of dialysis. Main Outcomes and Measures: The age- and sex-standardized mortality rate ratios (SMRs) with 95% CIs were calculated by dividing the mortality rates in patients receiving dialysis by the mortality rates in the general population for 3 equal periods (1998-2003, 2004-2009, and 2010-2015). Results: In total, 220467 patients receiving dialysis were included in the study. Their median (IQR) age was 68.2 (56.5-76.4) years, and 82068 patients (37.2%) were female. During follow-up, 83912 patients died, of whom 7662 (9.1%) died because of myocardial infarction, 5030 (6.0%) died because of stroke, and 435 (0.5%) died because of pulmonary embolism. Between the periods 1998 to 2003 and 2010 to 2015, the SMR of myocardial infarction decreased from 8.1 (95% CI, 7.8-8.3) to 6.8 (95% CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95% CI, 7.0-7.6) to 5.8 (95% CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95% CI, 7.6-10.1) to 5.5 (95% CI, 4.5-6.6). Conclusions and Relevance: In this cohort study of patients receiving dialysis, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more over time than in the general population.

Description:

The ERA Registry is funded by the European Renal Association (ERA). Dr Bos reported receiving grants from Zilveren Kruis Insurance outside the submitted work. Dr Arici reported receiving personal fees from Amgen, Astellas, Astra Zeneca, Bayer, Baxter, Boehringer Ingelheim, Menarini, Merck Sharp and Dohme, Novo Nordisk, Sandoz, and Sanofi outside the submitted work. Dr Wanner reported receiving grants from and being the president of the European Renal Association during the conduct of the study. Dr Santamaria reported receiving personal fees from AstraZeneca, Vifor Fresenius Medical Care Renal Pharma, and Boehringuer Ingelheim outside the submitted work. Dr Bell reported receiving personal fees from Astra Zeneca outside the submitted work. Dr Jager reported receiving grants from the European Renal Association during the conduct of the study and receiving personal fees from Fresenius Medical Care outside the submitted work. No other disclosures were reported. Publisher Copyright: © 2022 American Medical Association. All rights reserved.

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