Predictors for cardiovascular morbidity and overall mortality in Tunisian ESRD patients: a six year prospective study.
OBJECTIVE
The study was aimed to test the predictive value of several potential cardiovascular factors and markers for non fatal cardiovascular events (CVE) and overall mortality in Tunisian patients with renal failure.


METHODS
One hundred and fifteen renal failure patients were followed-up from 2000 to 2006. At enrollment, each patient underwent clinical examination and blood collection for analysis of lipid parameters, albumin, C reactive protein (CRP), parathyroid hormone (PTH), homocysteine and hemoglobin. Multivariate Cox regression models were applied to identify the predictors for non fatal CVE and overall mortality.


RESULTS
During the follow up, seventeen patients were lost. Among the 98 remaining patients, 29 presented a non fatal CVE (21.5%) and 15 were deceased (11.1%). In univariate analyses, non fatal CVE were more frequent in smokers and in patients with high PTH concentrations and low HDL levels. Moreover, low albumin concentrations were univariately associated with overall mortality. In the multivariate analysis, non fatal CVE was significantly and independently associated with age [hazard ratio (95% confidence interval), 1.04 (1.01-1.08); p=0.028] and the upper quartile of PTH concentrations [2.68 (1.24-5.81); p=0.013]. Overall mortality was independently predicted by the bottom quartile of albumin concentrations [5.62 (2.02-15.6); p=0.001] and the upper quartile of CRP concentrations [3.20 (1.14-8.79); p=0.027].


CONCLUSIONS
Advanced age and high PTH levels are the main predictors of CVE, whereas low albumin and high CRP concentrations are the independent predictors of death in Tunisian renal patients. A better control of these factors would greatly increase the patient's survival rates.
Fellah
Hayet
H
Lab-SM-01 Research Laboratory and Service of Biochemistry, Rabta Hospital, Tunis, Tunisia.
Hammami
Mohamed Bassem
MB
Feki
Moncef
M
Boubaker
Karima
K
Abdallah
Taieb Ben
TB
Lacour
Bernard
B
Mebazaa
Abderraouf
A
Kaabachi
Neziha
N
D000293:Adolescent; D000328:Adult; D000368:Aged; D000418:Albumins / Q000378:metabolism; D044383:Black People; D002097:C-Reactive Protein / Q000378:metabolism; D002318:Cardiovascular Diseases / Q000097:blood / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D016001:Confidence Intervals; D005260:Female; D006454:Hemoglobins / Q000378:metabolism; D006710:Homocysteine / Q000097:blood; D006801:Humans; D053208:Kaplan-Meier Estimate; D007676:Kidney Failure, Chronic / Q000097:blood / Q000378:metabolism / Q000401:mortality* / Q000473:pathology*; D008055:Lipids / Q000097:blood; D008297:Male; D008875:Middle Aged; D010281:Parathyroid Hormone / Q000097:blood; D016016:Proportional Hazards Models; D011446:Prospective Studies; D014416:Tunisia; D055815:Young Adult
D000418:Albumins; D006454:Hemoglobins; D008055:Lipids; D010281:Parathyroid Hormone; D006710:Homocysteine; D002097:C-Reactive Protein