Traditional Cardiovascular Disease Risk Factors in Dialysis Patients Compared with the General Population

Abstract

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...

Impact of Dyslipidemia in End-Stage Renal Disease

“…In a cross-sectional study of 1041 dialysis patients, the prevalence of atherosclerotic risk factors at the beginning of ESRD was compared with estimates of risk factors in normal adults from the US population derived from the Third National Health and Nutrition Examination (NHANES III) (6). That study found that dialysis patients had a high prevalence of diabetes (54%), hypertension (96%), LV hypertrophy by electrocardiogram (EKG) criteria (22%), low physical activity (80%), hypertriglyceridemia (36%), and low HDL cholesterol (HDL-C; 33%).…”

Overweight, Obesity, and the Development of Stage 3 CKD: The Framingham Heart Study

“…1 CKD is a risk factor for cardiovascular disease (CVD), 2; 3 and this association is partly mediated through the association between CKD and diabetes, hypertension, dyslipidemia, smoking, and obesity. [4][5][6][7] Obesity is a major global health concern, and it precedes the development of many CVD risk factors, including diabetes 9; 10 hypertension, 11; 12 and dyslipidemia. 13; 14 Therefore, obesity may mediate the association with CKD through these risk factors.…”

Desnutrição, inflamação e outros fatores de risco para doença cardiovascular em pacientes sob diálise peritoneal

“…Fatores de risco para DCV considerados tradicionais, como idade avançada, gênero masculino, hipertensão arterial, dislipidemia, diabetes mellitus, tabagismo, etilismo e inatividade física, são responsáveis por grande parte da alta mortalidade observada nessa população [3][4][5][6][7][8] . Pacientes em Diálise Peritoneal (DP), além de apresentarem alta prevalência de hipertensão e diabetes, também podem desenvolver hipertrigliceridemia grave, provavelmente devido à absorção de glicose do dialisato.…”