Section 3 CKD CVD and mortality Cardiovascular diseases

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 Age (years) 85

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

Cardiovascular Mortality Rates are Higher among Dialysis Patients 100 10 1 0. 01 0. 001 Adapted from Levey AS et al. Am J Kidney Dis 1998; 32: 853 -906. DOD/0401 -04 Dialysis: male Dialysis: female General population: female

CKD predicts CV events: HOPE study n=908 Events per 1000 person years n=8307 Creatinine <124 µmol/l HOPE=Heart Outcomes and Prevention Evaluation study Creatinine ≥ 124 µmol/l 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

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