Kidney replacement therapy: trends in incidence, treatment, and outcomes of myocardial infarction and stroke in a nationwide Scottish study

Peter J Gallacher, David Yeung, Samira Bell, Anoop S V Shah, Nicholas L Mills, Neeraj Dhaun

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Abstract / Description of output

Background and Aims: Patients with kidney failure have a higher risk of cardiovascular disease compared to the general population. Whilst temporal trends of myocardial infarction and stroke are declining in the general population, these have not been evaluated in patients with kidney failure. Our aim was to describe national trends in the incidence, treatment, and outcomes of myocardial infarction and stroke in patients with kidney failure (i.e., on dialysis or with a kidney transplant) over a 20-year period, stratified by age and sex.
Methods: In this retrospective national data-linkage study, all patients with kidney failure in Scotland (United Kingdom) receiving kidney replacement therapy between 01/01/1996 and 12/31/2016 were linked to national hospitalization, prescribing and death records. The primary outcomes were the incidence of myocardial infarction and stroke, and subsequent cardiovascular death. Generalized additive models were constructed to estimate age-standardized, sex-stratified incidence rates and trends in cardiovascular and all-cause death.
Results: Amongst 16,050 patients with kidney failure (52 [SD 15] years; 41.5% women), there were 1,992 (66 [SD 12] years; 34.8% women) and 996 (65 [SD 13] years; 45.1% women) incident myocardial infarctions and strokes between 01/01/1996 and 12/31/2016. During this period, the age-standardized incidence of myocardial infarction per 100,000 decreased in men (from 4,376 [95% confidence interval [CI] 3,998-4,785] to 1,835 [95%CI 1,692-1,988]) and women (from 3,268 [95%CI 2,982-3,593] to 1,369 [95%CI 1,257-1,491]). Similarly, the age-standardized incidence of stroke per 100,000 also decreased in men (from 1,978 [95%CI 1,795-2,175] to 799 [95%CI 729-875]) and women (from 2,234 [95%CI 2,031-2,468] to 903 [95%CI 824-990]).
Compared to the general population, the incidence of myocardial infarction was 4-8-fold higher in patients with kidney failure, whilst for stroke it was 2-4-fold higher. The use of evidence-based cardioprotective treatment increased over the study period and the predicted probability of cardiovascular death within 1 year of myocardial infarction for a 66-year-old patient with kidney failure (mean age of cohort) fell in men (76.6% to 38.6%) and women (76.8% to 38.8%), and also decreased in both sexes following stroke (men: 63.5% to 41.4%; women: 67.6% to 45.8%).
Conclusions: The incidence of myocardial infarction and stroke has halved in patients with kidney failure over the past 20 years but remains significantly higher than in the general population. Despite improvements in treatment and outcomes, the prognosis of these patients following myocardial infarction and stroke remains poor.
Original languageEnglish
Pages (from-to)1-13
JournalEuropean Heart Journal
Volume00
DOIs
Publication statusPublished - 1 Mar 2024

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