Nephrology Dialysis Transplantation, Vol 14, Issue 4 898-902, Copyright © 1999 by Oxford University Press
P Jungers, T Khoa, Z Massy, J Zingraff, M Labrunie, B Descamps-Latscha and N Man
Background. An abnormally high mortality from
atherosclerotic cardiovascular (CV) accidents has long been reported in
patients on maintenance haemodialysis (HD). However, incidence of
atherosclerotic CV accidents had not been so far assessed in predialysis
patients. In order to evaluate the respective influence of uraemia and the
dialysis procedure, we compared incidence of atherosclerotic accidents
before and after initiation of HD in a large population of patients.
Study design. A total of 748 patients (411 male) were
included in a retrospective study based on anamnestic data of patients
living on maintenance haemodialysis in March 1993 in nine dialysis units of
the Paris area. Incidence of first myocardial infarction (MI) or cerebral
infarction (CI) was calculated by reference to the number of years of
exposure to the risk both before and after initiation of HD in the various
age groups. Results. Overall, 103 first
atherosclerotic accidents were recorded, including 10 CI (7 males) and 93
MI (68 in males). Of the latter, 39 occurred before and 54 after start of
HD, at a mean (±SD) age of 62.4±9.9 and
63.7±11.1 years respectively. The annual incidence of MI in
males was 8.0, 19.5 and 28.3/1000 patient-years, before and 18.8, 21.6 and
29.9 patient-years after start of HD in the age groups 45-54.9, 55-64.9 and
⩾65 years respectively, compared to figures of 3.4, 7.5 and
10.4/1000 subject-years in the corresponding age groups in the general
French population. Conclusion. Incidence of
atherosclerotic CV accidents is nearly three times higher in uraemic
patients than in the general population in the same age range in both
genders. The fact that incidence and age at onset of first MI was similar
in predialysis and in dialysed patients suggests that the uraemic state
per se is a main determinant of such accelerated
atherosclerosis. Keywords: accelerated
atherosclerosis, cardiovascular accidents; cerebral infarction; chronic
renal failure; maintenance haemodialysis; myocardial infarction
ORIGINAL ARTICLES
Incidence of atherosclerotic arterial occlusive accidents in predialysis and dialysis patients: a multicentric study in the Ile de France district
Department of Nephrology and INSERM U90, Necker Hospital, 149 rue de Sèvres, F-75015 Paris, France; Corresponding author
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