title: Should we still focus that much on cardiovascular mortality in end stage renal disease patients? The CONvective TRAnsport STudy.
abstract: BACKGROUND
  We studied the distribution of causes of death in the CONTRAST cohort and compared the proportion of cardiovascular deaths with other populations to answer the question whether cardiovascular mortality is still the principal cause of death in end stage renal disease. In addition, we compared patients who died from the three most common death causes. Finally, we aimed to study factors related to dialysis withdrawal.
  
  
  METHODS
  We used data from CONTRAST, a randomized controlled trial in 714 chronic hemodialysis patients comparing the effects of online hemodiafiltration versus low-flux hemodialysis. Causes of death were adjudicated. The distribution of causes of death was compared to that of the Dutch dialysis registry and of the Dutch general population.
  
  
  RESULTS
  In CONTRAST, 231 patients died on treatment. 32% died from cardiovascular disease, 22% due to infection and 23% because of dialysis withdrawal. These proportions were similar to those in the Dutch dialysis registry and the proportional cardiovascular mortality was similar to that of the Dutch general population. cardiovascular death was more common in patients <60 years. Patients who withdrew were older, had more co-morbidity and a lower mental quality of life at baseline. Patients who withdrew had much co-morbidity. 46% died within 5 days after the last dialysis session.
  
  
  CONCLUSIONS
  Although the absolute risk of death is much higher, the proportion of cardiovascular deaths in a prevalent end stage renal disease population is similar to that of the general population. In older hemodialysis patients cardiovascular and non-cardiovascular death risk are equally important. Particularly the registration of dialysis withdrawal deserves attention. These findings may be partly limited to the Dutch population.
authors.affiliation: Department of Internal Medicine, Maasstad Hospital, Rotterdam, The Netherlands.
authors.forename: Claire H
authors.initials: CH
authors.lastname: den Hoedt
authors.forename: Michiel L
authors.initials: ML
authors.lastname: Bots
authors.forename: Muriel P C
authors.initials: MP
authors.lastname: Grooteman
authors.forename: Albert H A
authors.initials: AH
authors.lastname: Mazairac
authors.forename: E Lars
authors.initials: EL
authors.lastname: Penne
authors.forename: Neelke C
authors.initials: NC
authors.lastname: van der Weerd
authors.forename: Piet M
authors.initials: PM
authors.lastname: Ter Wee
authors.forename: Menso J
authors.initials: MJ
authors.lastname: Nubé
authors.forename: Renée
authors.initials: R
authors.lastname: Levesque
authors.forename: Peter J
authors.initials: PJ
authors.lastname: Blankestijn
authors.forename: Marinus A
authors.initials: MA
authors.lastname: van den Dorpel
mesh_terms: D017677:Age Distribution; D000368:Aged; D002318:Cardiovascular Diseases / Q000150:complications* / Q000401:mortality*; D002423:Cause of Death; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000401:mortality*; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D012042:Registries / Q000706:statistics & numerical data; D006435:Renal Dialysis / Q000706:statistics & numerical data