NDT Advance Access published online on July 4, 2007
Nephrology Dialysis Transplantation, doi:10.1093/ndt/gfm417
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Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the fosinopril in dialysis study
1Department of Nephrology, University Hospital of Nancy, 2Hypertension and Preventive Cardiology Division, Department of Cardiovascular disease, Centre d’Investigations Cliniques INSERM-CHU, INSERM U684, Nancy, France, 3Faculty of Medicine, Melbourne, Australia and Faculty of Economics, FUCAM, Louvain Academy, Belgium, 4Department of Nephrology, Hôpital Necker, Université Paris V – René Descartes, Paris, 5Department of Clinical Pharmacology and Centre d’Investigations Cliniques INSERM-CHU, University Hospital of Rouen, 6Clinical Pharmacology Unit, EA 3736, Université Claude Bernard Lyon 1, Lyon and 7Pharmacology Department, Pitié-Salpêtrière University Hospital, Assistance-Publique Hôpitaux de Paris, Paris 6 University, Paris, France
Correspondence and offprint requests to: Michèle Kessler, MD, Service de Néphrologie, Hôpitaux de Brabois, CHU de Nancy, 54500 Vandoeuvre les Nancy, France. Email: m.kessler{at}chu-nancy.fr
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Abstract |
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Background. Cardiovascular events (CVE) are a major cause of morbidity and mortality in end-stage renal disease (ESRD) patients. These patients are often excluded from CV clinical trials, and the prognostic factors associated with CVE in patients with ESRD have not been fully explored. A risk prediction model was created from the FOSIDIAL trial to identify factors predictive of CVE and to evaluate the relative strength of known predictors when considered together in a multivariate model.
Methods. FOSIDIAL was a prospective, randomized, double-blind study with 2-year follow-up and CVE adjudication. The study enrolled 397 patients with ESRD and left ventricular hypertrophy (LVH). CVE included cardiovascular death, non-fatal myocardial infarction, unstable angina, stroke, revascularization, heart failure hospitalization, resuscitated cardiac arrest and confirmed stroke. The model was built using a forward selection of all baseline variables. A structural equation model (SEM) was used to identify factors with an indirect association with CVE.
Results. CV history was the most important prognostic factor, followed by C-reactive protein (CRP), left ventricular mass index, diabetes and age. Smoking, low HDL, female gender and Kt/V were indirectly associated with CVE.
Conclusion. Prior CV disease, elevated CRP, LVH, diabetes or advanced age identifies patients at the highest risk for CVE. These data may be useful to detect high risk patients, to define potential targets for pharmacologic intervention, and to plan future studies in ESRD. Further research is needed to identify effective approaches that reduce the rate of CVE in these patients.
Keywords: cardiovascular disease; end-stage renal disease; morbidity; mortality
Received for publication: 12. 3.07
Accepted in revised form: 4. 6.07