Predictors of atherosclerotic events in patients on haemodialysis: post hoc analyses from the AURORA study.

Abstract

Background:

Patients on haemodialysis (HD) are at high risk for cardiovascular events, but heart failure and sudden death are more common than atherosclerotic events. The A Study to Evaluate the Use of Rosuvastatinin in Subjects on Regular Hemodialysis: An Assessment of Survival and Cardiovascular Events (AURORA) trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in 2773 HD patients. We studied predictors of the atherosclerotic cardiovascular events in AURORA.

Methods:

We readjudicated all deaths and presumed myocardial infarctions according to the criteria used in the Study of Heart and Renal Protection (SHARP); these were specifically developed to separate atherosclerotic from non-atherosclerotic cardiovascular events. The readjudicated atherosclerotic end point included the first event of the following: non-fatal myocardial infarction, fatal coronary heart disease, non-fatal and fatal non-haemorrhagic stroke, coronary revascularization procedures and death from ischaemic limb disease. Stepwise Cox regression analysis was used to identify the predictors of such events.

Results:

During a mean follow-up of 3.2 years, 506 patients experienced the new composite atherosclerotic outcome. Age, male sex, prevalent diabetes, prior cardiovascular disease, weekly dialysis duration, baseline albumin [hazard ratio (HR) 0.96; 95% confidence interval (CI) 0.94-0.99 per g/L increase], high-sensitivity C-reactive protein (HR 1.13; 95% CI 1.04-1.22 per mg/L increase) and oxidized low-density lipoprotein (LDL) cholesterol (HR 1.09; 95% CI 1.03-1.17 per 10 U/L increase) were selected as significant predictors in the model. Neither LDL cholesterol nor allocation to placebo/rosuvastatin therapy predicted the outcome.

Conclusions:

Even with the use of strict criteria for end point definition, non-traditional risk factors, but not lipid disturbances, predicted atherosclerotic events in HD patients.

• Authors: Marit D Solbu, Geir Mjøen, Patrick B Mark, Hallvard Holdaas, Bengt Fellström, Roland E Schmieder, Faiez Zannad, William G Herrington, Alan G Jardine
• Journal: Nephrology, dialysis, transplantation : official publication of the European Dialysis and Transplant Association - European Renal Association (Nephrol Dial Transplant) Vol. 33 Issue 1 Pg. 102-112 (01 01 2018) ISSN: 1460-2385 [Electronic] England
• PMID: 27798199 (Publication Type: Journal Article, Multicenter Study)
• Copyright: © The Author 2016. Published by Oxford University Press on behalf of ERA-EDTA. All rights reserved.

Chemical References

• Biomarkers
• Cholesterol, LDL
• C-Reactive Protein
• Cholesterol

Topics

• Aged
• Aged, 80 and over
• Atherosclerosis (diagnosis, etiology, metabolism)
• Biomarkers (analysis)
• C-Reactive Protein (metabolism)
• Cholesterol (metabolism)
• Cholesterol, LDL (metabolism)
• Female
• Humans
• Male
• Middle Aged
• Renal Dialysis (adverse effects)
• Risk Factors