End-stage kidney disease patients see excess IHD risk

Ischaemic heart disease (IHD) occurs more frequently among patients with end-stage kidney disease (ESKD), especially in women, a recent study has found.

Researchers conducted a retrospective cohort analysis of 10,766 ESKD patients (58.3 percent male) who contributed a total observation time of 44,149 years. The primary outcome was the incidence rate and incidence rate ratio (IRR) of any IHD event, using general population data as reference.

Over the study period, 1,961 patients were admitted 4,133 times for an IHD event. The most common first event leading to hospitalization was acute myocardial infarction (38.7 percent), followed by angina (37.1 percent) and chronic IHD (23.6 percent). The resulting incidence rate of admission for any IHD event was 4,442 per 100,000 person-years.

Compared to the general population, men with ESKD were more than 1.5 times as likely to develop IHD (IRR, 1.8, 95 percent confidence interval [CI], 1.7–1.9). Women with ESKD, on the other hand, were more than thrice as likely to have IHD (IRR, 3.4, 95 percent CI, 3.1–3.6).

Age also appeared to have a moderating effect, and the excess risk of IHD in ESKD patients declined with increasing age. Women with ESKD aged 30–49 years, for instance, were almost 10 times as likely as their general-population counterparts to have IHD (IRR, 9.8, 95 percent CI, 7.7–12.3).

“The findings from this study raise a number of important issues regarding the increased risk of cardiovascular disease in the ESKD population. This population has double the risk of IHD events irrespective of our current preventative strategies suggesting a need for revision of both evaluation and treatment strategies in this high-risk population,” researchers said.