Improved mortality rates for myocardial infarction, stroke, and pulmonary embolism in patients receiving dialysis between 1998 to 2015

1. Between 1998 to 2015, mortality rates for myocardial infarction, stroke, and pulmonary embolism decreased more in patients receiving dialysis than in the general population.

2. This improvement in mortality rate may be due to better predialysis and dialysis care.

Evidence Rating Level: 2 (Good)

Study Rundown: It is unclear whether advancements in the prevention and management of myocardial infarction, stroke, and pulmonary embolism in the general population over the past decades have also benefited patients receiving dialysis. This cohort study evaluated the trends in mortality rates for myocardial infarction, stroke, and pulmonary embolism in patients receiving dialysis compared with the general population. The main outcomes were age- and sex-standardized mortality rate ratios (SMRs) with 95%CIs comparing the mortality rates in patients receiving dialysis vs the general population for 3 periods (1998-2003, 2004-2009, and 2010-2015). Compared with the general population, SMRs for myocardial infarction, stroke, and pulmonary embolism decreased more in patients receiving dialysis, possibly owing to improvements in predialysis and dialysis care. A limitation of this study was the lack of information on comorbidities, medication use, and laboratory data resulting in residual confounding to the mortality trends detected.

Click to read the study in JAMA Network Open

Relevant Reading: Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients

In-Depth [retrospective cohort]: This cohort study included 220 467 adult patients (median [IQR] age, 68.2 [56.5-76.4] years; 82 068 [37.2%] female) who received dialysis between 1998-2015 from 11 European countries providing data to the European Renal Association. After 3-year follow-up, 83 912 patients died, of whom 7662 (9.1%) died from myocardial infarction, 5030 (6.0%) from stroke, and 435 (0.5%) from pulmonary embolism. Comparing the period between 1998-2003 and 2010-2015, the SMR of myocardial infarction decreased from 8.1 (95%CI, 7.8-8.3) to 6.8 (95%CI, 6.5-7.1), the SMR of stroke decreased from 7.3 (95%CI, 7.0-7.6) to 5.8 (95%CI, 5.5-6.2), and the SMR of pulmonary embolism decreased from 8.7 (95%CI, 7.6-10.1) to 5.5 (95%CI, 4.5-6.6).

Image: PD

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