Section 3: CKD, CVD and mortality

Cardiovascular diseases in CKD patients Damage to the heart (Uraemic cardiomyopathy) Damage to the arteries (Uraemic arteriopathy)

Cardiovascular Mortality Annual mortality (%) 100 Dialysis 10 General population 1 0.1 Male Female 0.01 Black White 25–34 35–44 45–54 55–64 65–74 75–84 85 Age (years)

Synergistic effect of CKD, CHF and Anemia as risk factors for Death 2 yr mortality (n~ 200,000 5% Medicare sample) % N= Collins, Adv studies in Med 2003

Cardiovascular Mortality Rates are Higher among Dialysis Patients Adapted from Levey AS et al. Am J Kidney Dis 1998; 32: 853-906. General population: male population: female Dialysis: male Dialysis: female 10 100 1 0.01 0.1 0.001 DOD/0401-04 Annual mortality (%) is significantly higher in the dialysis population than in control populations. While this difference is most marked in the younger subset of patients, it is still present in the elderly. Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis 1998; 32: 853-906. USRDS 1994-1996 (special data request, HCFA form 2746 no. 23, 26-29, and 31).

CKD predicts CV events: HOPE study Events per 1000 person years n=908 n=8307 Creatinine <124 µmol/l Creatinine ≥124 µmol/l HOPE=Heart Outcomes and Prevention Evaluation study Mann et al. Ann Intern Med 2001;134:629–636

Cause of death in dialysis patients

CKD Outcomes: Mortality and Dialysis Stage GFR (ml/min) RRT Death 2 60-89 1.1% 19.5% 3 30-59 1.3% 24.3% 4 15-29 19.9% 45.7% 27,998 CKD patients followed for 5 years Keith DS, AIM 2004;164:659-663

Prevalence of Co-morbidity and Level of GFR GFR <60 ml/min GFR 60 ml/min % DM Any CVD IHD CHF Stroke/TIA PVD