Predictors of cardiovascular events in patients with end-stage renal disease: an analysis from the Fosinopril in dialysis study.
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.
Kessler
Michèle
M
Department of Nephrology, University Hospital of Nancy, Nancy, France. m.kessler@chu-nancy.fr
Zannad
Faiez
F
Lehert
Philippe
P
Grünfeld
Jean Pierre
JP
Thuilliez
Christian
C
Leizorovicz
Alain
A
Lechat
Philippe
P
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
D000959:Antihypertensive Agents; D017328:Fosinopril