1. Both cardiovascular and non-cardiovascular diseases are important causes of death in dialysis patients:
A comparison with the general population
Minako Wakasugi 1,2, Junichiro James Kazama 2,3, and Ichiei Narita 2
1Center for Inter-organ Communication Research and 2Division of Clinical Nephrology and Rheumatology,
Niigata University Graduate School of Medical and Dental Sciences,
3Division of Blood Purification Therapy, Niigata University Medical and Dental Hospital, Niigata, Japan
AIM
SUMMARY POINTS
✓Both CV and non-CV mortality are important to improve the prognosis of Japanese dialysis patients.
✓More attention should be paid to not only CV but also non-CV mortality on clinical management and research in uremia.
To compare cardiovascular (CV) and non-CV mortality rates in dialysis patients (DP) with those in the general Japanese population (GP).
BACKGROUND
METHODS3) ?
Is CVD really the main cause of death
in the Japanese dialysis patients
The Japanese Society for Dialysis Therapy (JSDT) registry
A national Vital Statistics survey
Japanese CV mortality is relatively low compared to other countries.
The top 3 of causes of death are cancer, heart disease, and pneumonia in the Japanese general population.
Age-adjusted atherosclerotic cardiovascular Diseases(ASCVD) mortality in the general population(GP) and dialysis populations (DP) from 21 countries.
Created based upon data from [1].
Age-Adjusted ASCVD Mortality in the GP,
per 1000 population
Age-Adjusted ASCVD Mortality in the DP,
Japan
Sweden US
Germany UK
Singapore
Norway
Austria
Australia
Greece
Finland
Denmark
New Zealand
Belgium
Mexico
Netherlands
Republic of Korea
France
Spain
Italy
Canada
Causes of death were followed by the JSDT definition using the 10th modified edition of the International Classification of Diseases (ICD-10) codes .
Cancer
(28.5%)
Heart disease
(15.6%)
Pneumonia
(10.0%)
Cerebrovascular disorders
CVD (cardiovascular disease)
Heart failure, cerebrovascular disorder, myocardial infarction, hyperkalemia/sudden death, and pulmonary thromboembolism.
Non-CVD (noncardiovascular disease)
Infection, malignancies, cachexia/uremia, chronic hepatitis/cirrhosis, ileus, bleeding, suicide/refusal of treatment, and miscellaneous.
Created based upon data from [2].
RESULTS
Accidental deaths and deaths with unknown causes were excluded from analysis.
Statistical Analysis
Mortality rates were calculated by dividing the number of deaths by the number of person-years accumulated during the study period.
Age-adjusted mortality rate difference were calculated to determine whether there was excess mortality in dialysis patients compared with the general population on an absolute scale.
During the 2-year study period, there were 2,284,272 and 51,432 deaths out of 252 million person-years and 546,474 dialysis patient-years, respectively.
Heart failure
per 1,000 person-years
Mortality rate,
Age, years
Non-CV mortality (DP)
Infection
Cerebrovascular
disorder
per 1,000 person-years
Mortality rate,
CV mortality (DP)
Age, years
Mortality rate, per 1,000 person-years
Myocardial
infarction
Non-CV mortality (GP)
CV mortality
(GP)
Age, years
Age-adjusted mortality rate difference for non-CVD (30.0 per 1,000 person-years) was comparable to that for CVD (33.1 per 1,000 person-years).
Suicide/Refusal of treatment
Miscellaneous
Pulmonary thrombo-
embolism
This finding indicates that preventions of both CV and non-CV deaths are equally important for decreasing all cause mortality among Japanese dialysis patients.
Non-CVD
CVD
REFERENCES
ACKNOWLEDGMENTS
1) Yoshino M, et al. J Am Soc Nephrol. 17: 3510–3519,2006 2)
3) Wakasugi M, et al. Ther Apher Dial. 17: ,2013
We thank the Committee of the Renal Data Registry of the Japanese Society for Dialysis Therapy (JSDT) for permission to use the data. The opinions reflected in this manuscript are those of the authors alone and do not reflect an official position of JSDT.
None of the authors have any conflicts of interest associated with this study.