International Differences in Dialysis Mortality Reflect Background General Population Atherosclerotic Cardiovascular Mortality

Abstract

Existing national, racial, and ethnic differences in dialysis patient mortality rates largely are unexplained. This study aimed to test the hypothesis that mortality rates related to atherosclerotic cardiovascular disease (ASCVD) in dialysis populations (DP) and in the background general populations (GP) are correlated. In a cross-sectional, multinational study, all-cause and ASCVD mortality rates were compared between GP and DP using the most recent data from the World Health Organization mortality database (67 countries; 1,571,852,000 population) and from national renal registries (26 countries; 623,900 population). Across GP of 67 countries (14,082,146 deaths), all-cause mortality rates (median 8.88 per 1000 population; range 1.93 to 15.40) were strongly related to ASCVD mortality rates (median 3.21; range 0.53 to 8.69), with Eastern European countries clustering in the upper and Southeast and East Asian countries in the lower rate ranges. Across DP (103,432 deaths), mortality rates from all causes (median 166.20; range 54.47 to 268.80) and from ASCVD (median 63.39 per 1000 population; range 21.52 to 162.40) were higher and strongly correlated. ASCVD mortality rates in DP and in the GP were significantly correlated; the relationship became even stronger after adjustment for age (R 2 ‫؍‬ 0.56, P < 0.0001). A substantial portion of the variability in mortality rates that were observed across DP worldwide is attributable to the variability in background ASCVD mortality rates in the respective GP. Genetic and environmental factors may underlie these differences.

The Challenge of Sudden Death in Dialysis Patients

“…The European and worldwide experience suggests that the frequency of cardiac death in the dialysis population varies in parallel with its frequency in the background population: 27% of the variation in the frequency of cardiac death in the dialysis population is explained by the mortality in the general population (16,17). This observation would suggest that the dialyzed patients largely die as the result of the same cardiovascular causes as individuals in the general population.…”

International Hemodialysis Patient Outcomes Comparisons Revisited

“…Regional US data have shown that mortality for dialysis patients varies by region and correlates with mortality differences in the general population (8); therefore, one may hypothesize that higher mortality in US dialysis patients is partly explained by higher mortality in the general population. Using data from national ESRD registries and DOPPS, Yoshino et al (9) correlated national mortality rates among dialysis patients with national mortality data for the general population from the World Health Organization. A strong association was found, suggesting that countries with relatively high mortality rates in the general population also have relatively high mortality rates in the dialysis population.…”

Effect of Membrane Permeability on Survival of Hemodialysis Patients

“…doi: 10.1681 Patients who have stage 5 chronic kidney disease (CKD) and are on dialysis therapy have a high mortality rate, estimated between 14 and 26% in Europe and at 24% per year in the United States. 1 The accumulation of various retention solutes over a broad range of molecular weights and chemical composition is involved in the complex pathophysiology of uremia and, among other factors, implicated in the high mortality observed in CKD. 2 Because of their higher porosity, high-flux hemodialysis (HD) membranes have the capacity to remove retention solutes of higher molecular weight than do low-flux membranes, 3 which contain smaller pores.…”