1. Section 3: CKD, CVD and mortality

2. Cardiovascular diseases in CKD patients
Damage to the heart
(Uraemic cardiomyopathy)
Damage to the arteries
(Uraemic arteriopathy)

4. Cardiovascular Mortality
Annual mortality (%)
100
Dialysis 10
General population 1
0.1
Male
Female
0.01
Black
White
25–34
35–44
45–54
55–64
65–74
75–84
85
Age (years)

5. Synergistic effect of CKD, CHF and Anemia as risk factors for Death
2 yr mortality (n~ 200,000 5% Medicare sample) % N=
Collins, Adv studies in Med 2003

6. Cardiovascular Mortality Rates are Higher among Dialysis Patients
Adapted from Levey AS et al. Am J Kidney Dis 1998; 32:
General
population: male
population: female
Dialysis: male
Dialysis: female 10
100 1
0.01
0.1
0.001
DOD/
Annual mortality (%) is significantly higher in the dialysis population than in control populations. While this difference is most marked in the younger subset of patients, it is still present in the elderly.
Levey AS, Beto JA, Coronado BE, et al. Controlling the epidemic of cardiovascular disease in chronic renal disease: What do we know? What do we need to learn? Where do we go from here? Am J Kidney Dis 1998; 32:
USRDS (special data request, HCFA form 2746 no. 23, 26-29, and 31).

7. CKD predicts CV events: HOPE study
Events per 1000 person years
n=908
n=8307
Creatinine <124 µmol/l
Creatinine ≥124 µmol/l
HOPE=Heart Outcomes and Prevention Evaluation study
Mann et al. Ann Intern Med 2001;134:629–636

8. Cause of death in dialysis patients

9. CKD Outcomes: Mortality and Dialysis
Stage
GFR (ml/min)
RRT
Death 2
60-89
1.1%
19.5% 3
30-59
1.3%
24.3% 4
15-29
19.9%
45.7%
27,998 CKD patients followed for 5 years
Keith DS, AIM 2004;164:

10. Prevalence of Co-morbidity and Level of GFR
GFR <60 ml/min
GFR 60 ml/min % DM
Any CVD
IHD
CHF
Stroke/TIA
PVD