title: Declining mortality rates despite increases in clinical coronary artery disease among US dialysis patients: a national registry study.
abstract: OBJECTIVE
  Coronary artery disease (CAD) is a major risk factor for death on dialysis. The objective of this study was to compare prevalent trends and patterns of survival in successive national cohorts.
  
  
  METHODS
  National data on 823,753 incident dialysis patients, aged 18 and over, were analyzed from the US Renal Data System from 1995 to 2004. The prevalence of CAD was compared across calendar years by sex and race categorized as; White, Black, Asian and Native American/Alaskan Native (Native Am). Two-year mortality rates were determined for annual cohorts and multivariable Cox regression compared hazard ratios (HR) and 95% confidence intervals.
  
  
  RESULTS
  From 1995 to 2004, the annual prevalence of CAD increased significantly in men from 25.2 to 30.1% and in women from 22.1 to 25.3%, p < 0.001. For men, the rise in prevalence was largely due to increases among Black men and older White men. For women, the pattern was similar. During this period, death rates decreased significantly from 379 to 348 and from 396 to 357 per 1,000 person-years in men and women respectively. Multivariate analysis identified significant reductions in mortality with advancing calendar year for White (HR 0.98 (0.98-0.99)), Asian (HR 0.93 (0.91-0.96)), and Native Am men (HR 0.95 (0.90-0.99)), and for White (HR 0.99 (0.98-0.99)) and Native Am women (HR 0.93 (0.89-0.98)). No significant trends were observed for Black patients.
  
  
  CONCLUSIONS
  Despite a rising burden of CAD among incident US dialysis patients, mortality rates have fallen for most groups. Substantial racial disparities remain.
authors.affiliation: Departments of Nephrology and Medicine, University Hospital Limerick, Limerick, Ireland. Austin.stack@ul.ie
authors.forename: Austin G
authors.initials: AG
authors.lastname: Stack
authors.forename: Antoinette M
authors.initials: AM
authors.lastname: Neylon
authors.forename: Ahad A
authors.initials: AA
authors.lastname: Abdalla
authors.forename: Avril
authors.initials: A
authors.lastname: Hegarty
authors.forename: Ailish
authors.initials: A
authors.lastname: Hannigan
authors.forename: Cornelius J
authors.initials: CJ
authors.lastname: Cronin
authors.forename: Hoang T
authors.initials: HT
authors.lastname: Nguyen
authors.forename: Liam F
authors.initials: LF
authors.lastname: Casserly
mesh_terms: D000368:Aged; D015897:Comorbidity; D003324:Coronary Artery Disease / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D005260:Female; D006801:Humans; D007676:Kidney Failure, Chronic / Q000453:epidemiology / Q000401:mortality* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D009026:Mortality / Q000639:trends*; D015995:Prevalence; D012042:Registries; D006435:Renal Dialysis / Q000401:mortality*; D014481:United States / Q000453:epidemiology