title: International differences in dialysis mortality reflect background general population atherosclerotic cardiovascular mortality.
abstract: 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.
authors.affiliation: Renal Research Institute, 207 East 94th Street, Suite 303, New York, NY 10128, USA.
authors.forename: Maki
authors.initials: M
authors.lastname: Yoshino
authors.forename: Martin K
authors.initials: MK
authors.lastname: Kuhlmann
authors.forename: Peter
authors.initials: P
authors.lastname: Kotanko
authors.forename: Roger N
authors.initials: RN
authors.lastname: Greenwood
authors.forename: Ronald L
authors.initials: RL
authors.lastname: Pisoni
authors.forename: Friedrich K
authors.initials: FK
authors.lastname: Port
authors.forename: Kitty J
authors.initials: KJ
authors.lastname: Jager
authors.forename: Peter
authors.initials: P
authors.lastname: Homel
authors.forename: Hans
authors.initials: H
authors.lastname: Augustijn
authors.forename: Frank T
authors.initials: FT
authors.lastname: de Charro
authors.forename: Frederic
authors.initials: F
authors.lastname: Collart
authors.forename: Ekrem
authors.initials: E
authors.lastname: Erek
authors.forename: Patrik
authors.initials: P
authors.lastname: Finne
authors.forename: Guillermo
authors.initials: G
authors.lastname: Garcia-Garcia
authors.forename: Carola
authors.initials: C
authors.lastname: Grönhagen-Riska
authors.forename: George A
authors.initials: GA
authors.lastname: Ioannidis
authors.forename: Frank
authors.initials: F
authors.lastname: Ivis
authors.forename: Torbjorn
authors.initials: T
authors.lastname: Leivestad
authors.forename: Hans
authors.initials: H
authors.lastname: Løkkegaard
authors.forename: Frantisek
authors.initials: F
authors.lastname: Lopot
authors.forename: Dong-Chan
authors.initials: DC
authors.lastname: Jin
authors.forename: Reinhard
authors.initials: R
authors.lastname: Kramar
authors.forename: Toshiyuki
authors.initials: T
authors.lastname: Nakao
authors.forename: Mooppil
authors.initials: M
authors.lastname: Nandakumar
authors.forename: Sylvia
authors.initials: S
authors.lastname: Ramirez
authors.forename: Frank M
authors.initials: FM
authors.lastname: van der Sande
authors.forename: Staffan
authors.initials: S
authors.lastname: Schön
authors.forename: Keith
authors.initials: K
authors.lastname: Simpson
authors.forename: Rowan G
authors.initials: RG
authors.lastname: Walker
authors.forename: Wojciech
authors.initials: W
authors.lastname: Zaluska
authors.forename: Nathan W
authors.initials: NW
authors.lastname: Levin
mesh_terms: 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*