Abstract. Although atherosclerotic cardiovascular disease (AS-CVD) risk in end-stage renal disease (ESRD) is 5 to 30 times that of the general population, few data exist comparing AS-CVD risk factors among new dialysis patients to the general population. This cross-sectional study of 1041 dialysis patients describes the prevalence of ASCVD risk factors at the beginning of ESRD compared with estimates of ASCVD risk factors in the adult US population derived from the Third National Health and Nutrition Examination (NHANES III). CHOICE Study participants had a high prevalence of diabetes (54%), hypertension (96%), left ventricular hypertrophy by electrocardiogram (EKG) criteria (22%), low physical activity (80%), hypertriglyceridemia (36%), and low HDL cholesterol (33%). CHOICE participants were more likely to be older, black, and male than NHANES III participants. After adjustment for age, race, gender, and ASCVD (defined as myocardial infarction, revascularization procedure, stroke, carotid endarterectomy, and amputation in CHOICE; and as myocardial infarction and stroke in NHANES III), the prevalence of diabetes, hypertension, left ventricular hypertrophy by EKG, low physical activity, low HDL cholesterol, and hypertriglyceridemia were still more common in CHOICE participants. Smoking, obesity, hypercholesterolemia, and high LDL cholesterol, however, were less common in CHOICE than NHANES III participants. The projected 5-yr ASCVD risk based on the Framingham Risk Equation among those older than 40 yr without ASCVD was higher in CHOICE Study participants (13%) than in the NHANES III participants (6%). In summary, many ASCVD risk factors are more prevalent in ESRD than in the general population and may explain some, but probably not all, of the increased ASCVD risk in ESRD.Atherosclerotic cardiovascular disease (ASCVD) accounts for approximately half of deaths in end-stage renal disease (ESRD) and contributes to the extraordinarily high total annual mortality of 23% observed in such patients (1). The incidence of myocardial infarction (MI) and stroke in the dialysis population is 5-to 15-fold higher in ESRD (2), and cardiovascular mortality is 10-to 30-fold higher (3) than that seen in the general population (4 -6), This increased risk is only partially explained by a high prevalence of ASCVD (2,4,7-9) and traditional ASCVD risk factors (10) at the initiation of dialysis (3,11,12).The Special Report from the National Kidney Foundation Task Force on Cardiovascular Disease (13) called for further studies of ASCVD and its risk factors in ESRD patients. Most previous studies of ASCVD risk factors have investigated prevalent . Such studies may underestimate the presence and effect of risk factors because those with the highest degree of ASCVD risk tend to die sooner and are not included in a prevalent study population (i.e., survival bias), an effect diminished but not eliminated by cross-sectional studies of incident dialysis patients.Relatively few nationally representative studies (4,9,18 -20) have described select...

The HEMO Study results demonstrate the marked burden of chronic kidney failure and hemodialysis treatment on daily life. In this trial among patients undergoing maintenance three times a week hemodialysis, the SF-36 physical component summary score and pain scale showed significant but very small clinical effects favoring the higher dialysis dose. No clinically meaningful benefits or either the dose or flux interventions were observed for other indices of health-related quality of life.

Future efforts to increase the prevalence of fistulas in hemodialysis patients should be directed at both hemodialysis units and patient subpopulations with a low fistula prevalence.

We conclude that comorbidity assessment using the ICED is feasible in multicenter clinical trials of dialysis patients. There is a large burden of comorbidity in dialysis patients, which is not well explained by the cause of renal disease, demographic, and socioeconomic factors and common clinical and laboratory measurements. These variables should not be considered substitutes for comorbid conditions in case-mix adjustment. Comorbidity assessment is useful to describe the sample population, to improve the precision of the treatment effect, and to use possibly as an outcome measurement.

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