Risk factors associated with cardiovascular morbidity and mortality in Spanish incident hemodialysis patients: two-year results from the ANSWER study

Abstract

Aims: To identify factors associated with cardiovascular (CV) disease in hemodialysis.

Methods: Multicenter, prospective, 2-year, observational study in 2,310 incident patients (3,496 patient-years). Multivariate Cox models determined baseline characteristics associated with CV disease.

Results: Main factors associated with CV deaths (6.3/100 patient-years) were: high Charlson score (hazard ratio (HR) 3.6; 95% confidence interval (CI) 1.7-7.5 for ≥9 vs. ≤4); low Karnofsky score (KS; HR 2.2; 95% CI 1.5-3.3 for KS ≤50 vs. >70); female gender (HR 1.4; 95% CI 1.1-1.9); catheter access (HR 1.4; 95% CI 1.0-1.9); low (<3.5 g/dl) albumin (HR 2.5; 95% CI 1.8-3.3); ferritin deficiency (HR 1.6; 95% CI 1.2-2.2 for <100 vs. ≥100-500 ng/ml) and low body mass index (BMI; HR 1.9; 95% CI 1.2-3.0 for <20 vs. 20-25). A BMI of ≥30 was a protective factor (HR 0.6; 95% CI 0.4-0.9).

Conclusions: There is a high CV risk, especially in older patients with high comorbidity, low BMI, low albumin or iron deficiency. Catheter access increases the CV death risk.