International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality.
Existing national, racial, and ethnic differences in dialysis patient mortality rates largely are unexplained. This study aimed to test the hypothesis that mortality rates related to atherosclerotic cardiovascular disease (ASCVD) in dialysis populations (DP) and in the background general populations (GP) are correlated. In a cross-sectional, multinational study, all-cause and ASCVD mortality rates were compared between GP and DP using the most recent data from the World Health Organization mortality database (67 countries; 1,571,852,000 population) and from national renal registries (26 countries; 623,900 population). Across GP of 67 countries (14,082,146 deaths), all-cause mortality rates (median 8.88 per 1000 population; range 1.93 to 15.40) were strongly related to ASCVD mortality rates (median 3.21; range 0.53 to 8.69), with Eastern European countries clustering in the upper and Southeast and East Asian countries in the lower rate ranges. Across DP (103,432 deaths), mortality rates from all causes (median 166.20; range 54.47 to 268.80) and from ASCVD (median 63.39 per 1000 population; range 21.52 to 162.40) were higher and strongly correlated. ASCVD mortality rates in DP and in the GP were significantly correlated; the relationship became even stronger after adjustment for age (R(2) = 0.56, P < 0.0001). A substantial portion of the variability in mortality rates that were observed across DP worldwide is attributable to the variability in background ASCVD mortality rates in the respective GP. Genetic and environmental factors may underlie these differences.
Yoshino
Maki
M
Renal Research Institute, 207 East 94th Street, Suite 303, New York, NY 10128, USA.
Kuhlmann
Martin K
MK
Kotanko
Peter
P
Greenwood
Roger N
RN
Pisoni
Ronald L
RL
Port
Friedrich K
FK
Jager
Kitty J
KJ
Homel
Peter
P
Augustijn
Hans
H
de Charro
Frank T
FT
Collart
Frederic
F
Erek
Ekrem
E
Finne
Patrik
P
Garcia-Garcia
Guillermo
G
Grönhagen-Riska
Carola
C
Ioannidis
George A
GA
Ivis
Frank
F
Leivestad
Torbjorn
T
Løkkegaard
Hans
H
Lopot
Frantisek
F
Jin
Dong-Chan
DC
Kramar
Reinhard
R
Nakao
Toshiyuki
T
Nandakumar
Mooppil
M
Ramirez
Sylvia
S
van der Sande
Frank M
FM
Schön
Staffan
S
Simpson
Keith
K
Walker
Rowan G
RG
Zaluska
Wojciech
W
Levin
Nathan W
NW
D050197:Atherosclerosis / Q000208:ethnology / Q000401:mortality*; D002423:Cause of Death; D003430:Cross-Sectional Studies; D003469:Culture; D014943:Global Health; D006801:Humans; D038622:Internationality; D006435:Renal Dialysis / Q000401:mortality*