title: Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the Fosinopril in dialysis study.
abstract: BACKGROUND
  Cardiovascular events (CVE) are a major cause of morbidity and mortality in end-stage renal disease (ESRD) patients. These patients are often excluded from CV clinical trials, and the prognostic factors associated with CVE in patients with ESRD have not been fully explored. A risk prediction model was created from the FOSIDIAL trial to identify factors predictive of CVE and to evaluate the relative strength of known predictors when considered together in a multivariate model.
  
  
  METHODS
  FOSIDIAL was a prospective, randomized, double-blind study with 2-year follow-up and CVE adjudication. The study enrolled 397 patients with ESRD and left ventricular hypertrophy (LVH). CVE included cardiovascular death, non-fatal myocardial infarction, unstable angina, stroke, revascularization, heart failure hospitalization, resuscitated cardiac arrest and confirmed stroke. The model was built using a forward selection of all baseline variables. A structural equation model (SEM) was used to identify factors with an indirect association with CVE.
  
  
  RESULTS
  CV history was the most important prognostic factor, followed by C-reactive protein (CRP), left ventricular mass index, diabetes and age. Smoking, low HDL, female gender and Kt/V were indirectly associated with CVE.
  
  
  CONCLUSIONS
  Prior CV disease, elevated CRP, LVH, diabetes or advanced age identifies patients at the highest risk for CVE. These data may be useful to detect high risk patients, to define potential targets for pharmacologic intervention, and to plan future studies in ESRD. Further research is needed to identify effective approaches that reduce the rate of CVE in these patients.
authors.affiliation: Department of Nephrology, University Hospital of Nancy, Nancy, France. m.kessler@chu-nancy.fr
authors.forename: Michèle
authors.initials: M
authors.lastname: Kessler
authors.forename: Faiez
authors.initials: F
authors.lastname: Zannad
authors.forename: Philippe
authors.initials: P
authors.lastname: Lehert
authors.forename: Jean Pierre
authors.initials: JP
authors.lastname: Grünfeld
authors.forename: Christian
authors.initials: C
authors.lastname: Thuilliez
authors.forename: Alain
authors.initials: A
authors.lastname: Leizorovicz
authors.forename: Philippe
authors.initials: P
authors.lastname: Lechat
mesh_terms: D000368:Aged; D000959:Antihypertensive Agents / Q000627:therapeutic use; D002318:Cardiovascular Diseases / Q000209:etiology*; D005260:Female; D017328:Fosinopril / Q000627:therapeutic use; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy*; D008297:Male; D015233:Models, Statistical; D015337:Multicenter Studies as Topic; D011379:Prognosis; D011446:Prospective Studies; D016032:Randomized Controlled Trials as Topic; D006435:Renal Dialysis; D012307:Risk Factors
chemical_list: D000959:Antihypertensive Agents; D017328:Fosinopril