title: Relationship between history of coronary heart disease at dialysis initiation and onset of events associated with heart disease: a propensity-matched analysis of a prospective cohort study.
abstract: BACKGROUND
  Chronic kidney disease (CKD) is an independent risk factor for cardiovascular disease (CVD) events, and a number of reports have shown a relationship between CKD and CVD in pre-dialysis or maintenance dialysis patients. However, few studies have reported serial observations during dialysis initiation and maintenance. Therefore, we examined whether the incidence of heart disease events differed between CKD patients with and without a history of coronary heart disease (CHD) at dialysis initiation.
  
  
  METHODS
  The subjects were patients in the 17 centers participating in the Aichi Cohort Study of Prognosis in Patients Newly Initiated into Dialysis (AICOPP) from October 2011 to September 2013. We excluded nine patients whose outcomes were unknown, as determined by a survey conducted at the end of March 2015. Thus, we enrolled 1,515 subjects into the study. We classified patients into 2 groups according to the history of CHD (i.e., a CHD group and a non-CHD group). Propensity scores (PS) represented the probability of being assigned to a group with or without a history of CHD. Onset of heart disease events and associated mortality and all-cause mortality were compared in PS-matched patients by using the log-rank test for Kaplan-Meier curves. Factors contributing to heart disease events were examined using stepwise multivariate Cox proportional hazards analysis.
  
  
  RESULTS
  There were 254 patients in each group after PS-matching. During observation, heart disease events occurred in 85 patients (33.5%) in the CHD group and 48 (18.9%) patients in the non-CHD group. The incidence was significantly higher in the CHD group (p < 0.0001). The CHD group was associated with higher incidence of heart disease events (vs. the non-CHD group, hazard ratio = 1.750, 95% confidence interval = 1.160-2.639). In addition, comorbidities such as diabetes mellitus, low body mass index, and low serum high-density lipoprotein cholesterol were associated with higher incidence of events.
  
  
  CONCLUSIONS
  History of CHD at dialysis initiation was associated with a higher incidence of heart disease events and mortality and all-cause mortality.
  
  
  BACKGROUND
  UMIN 000007096 . Registered 18 January 2012.
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan. daijo@fujita-hu.ac.jp.|The Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP) Group, Aichi, Japan. daijo@fujita-hu.ac.jp.
authors.forename: Daijo
authors.initials: D
authors.lastname: Inaguma
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.|The Aichi Cohort Study of Prognosis in Patients Newly Initiated Into Dialysis (AICOPP) Group, Aichi, Japan.
authors.forename: Shigehisa
authors.initials: S
authors.lastname: Koide
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Kazuo
authors.initials: K
authors.lastname: Takahashi
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Hiroki
authors.initials: H
authors.lastname: Hayashi
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Midori
authors.initials: M
authors.lastname: Hasegawa
authors.affiliation: Department of Nephrology, Fujita Health University School of Medicine, Toyoake, Aichi, Japan.
authors.forename: Yukio
authors.initials: Y
authors.lastname: Yuzawa
mesh_terms: D000368:Aged; D059347:Cardio-Renal Syndrome / Q000401:mortality* / Q000517:prevention & control; D015331:Cohort Studies; D015897:Comorbidity; D003327:Coronary Disease / Q000175:diagnosis / Q000401:mortality*; D005260:Female; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D015994:Incidence; D007564:Japan / Q000453:epidemiology; D008297:Male; D011379:Prognosis; D057216:Propensity Score; D011446:Prospective Studies; D006435:Renal Dialysis / Q000401:mortality* / Q000706:statistics & numerical data*; D051436:Renal Insufficiency, Chronic / Q000401:mortality* / Q000628:therapy*; D012307:Risk Factors; D015996:Survival Rate; D061665:Time-to-Treatment
keywords: Cardiovascular disease; Chronic kidney disease; Coronary heart disease; Dialysis initiation; Mortality