Nephrology Dialysis Transplantation, Vol 12, Issue 12 2597-2602, Copyright © 1997 by Oxford University Press
P Jungers, Z Massy, T Khoa, C Fumeron, M Labrunie, B Lacour, B Descamps-Latscha and N Man
Background: Accelerated atherosclerosis resulting in
an abnormally high incidence of coronary and cerebrovascular occlusive
accidents has been repeatedly reported in dialysis patients, but incidence
and risk factors of such complications in chronic renal failure (CRF)
predialysis patients are debated. Methods: We
Prospectively assessed the incidence of first myocardial and cerebral
infarction episodes in a cohort of 147 CRF patients (99 male) followed from
January 1985 to December 1994. Relevant clinical and laboratory risk
factors for atherogenesis were determined at yearly intervals. They
included blood pressure, smoking, blood lipids, fibrinogen, and
homocysteine which were compared in patients with (CVA+) or without (CVA-)
occurrence of cardiovascular (CV) atherosclerotic accidents.
Results: Incidence of CV accidents was nearly three
times higher in CRF patients than in the French general population in both
genders. In particular, incidence of myocardial infarction in male patients
aged 45-55, 55-65 and >65 years was 7.6, 18.2, and 27.8/1000
patient-years, respectively, compared to 3.4, 8.9 and 10.4/1000
subject-years in the general population. Although age and degree of renal
failure at onset of CV events or at end of follow-up did not differ between
CVA+ and CVA- groups, cigarette smoking (24.5 [SD 24.3] vs 8.2 [14.7]
pack-years, P <0.0001) and systolic blood pressure (159 [19] vs 148
[1] mmHg, P <0.001) were markedly higher in CVA+ patients.
Similarly, mean plasma HDL-cholesterol was lower, whereas LDL-cholesterol,
triglycerides, apoB, Lp(a), fibrinogen, and homocysteine levels all were
significantly higher in CVA+ than in CVA- patients. Multivariate Cox
analysis identified cigarette smoking, systolic pressure, HDL cholesterol,
and fibrinogen as independent risk factors for developing CV accidents.
Conclusions: Incidence of atherosclerotic CV
complications is abnormally high in predialysis CRF patients, suggesting
that the uraemic state per se is associated with
atherogenesis. As several of the identified clinical and metabolic risk
factors for such accidents are potentially remediable by specific
therapeutic interventions, prophylactic measures should be initiated long
before start of renal replacement therapy. Key words:
accelerated atherosclerosis; atherogenic risk factors; cardiovascular
accidents; cerebral infarction; chronic renal failure; myocardial
infarction
ORIGINAL ARTICLES
Incidence and risk factors of atherosclerotic cardiovascular accidents in predialysis chronic renal failure patients: a prospective study
Department of Nephrology, Department of Biochemistry and INSERM U90, Necker Hospital, 149 rue de Sevres, 75015 Paris, France; Corresponding author
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