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 (%) 25–3445–5465–74  85 35–4455–6475–84 Male Female Black White Dialysis General population Age (years)

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

Cardiovascular Mortality Rates are Higher among Dialysis Patients Adapted from Levey AS et al. Am J Kidney Dis 1998; 32: General population: male General population: female Dialysis: male Dialysis: female DOD/

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

Cause of death in dialysis patients

CKD Outcomes: Mortality and Dialysis StageGFR (ml/min)RRTDeath %19.5% %24.3% %45.7% 27,998 CKD patients followed for 5 years Keith DS, AIM 2004;164:

Prevalence of Co-morbidity and Level of GFR % GFR  60 ml/min GFR <60 ml/min DMCHFStroke/ TIA PVDAny CVD IHD