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Nephrol Dial Transplant. 2013 Aug;28(8):2082-9. doi: 10.1093/ndt/gft048. Epub 2013 Mar 6.

Trend from cardiovascular to non-cardiovascular late mortality in patients with renal replacement therapy since childhood.

Author information

1
Department of Paediatric Nephrology, Academic Medical Centre, Emma Children's Hospital, Amsterdam, the Netherlands.

Abstract

BACKGROUND:

To evaluate transitions in causes of death in patients with renal replacement therapy (RRT) since childhood over time, we performed a 10-year extension of the Late Effects of Renal Insufficiency in Children (LERIC) study.

METHODS:

The LERIC cohort consisted of all 249 Dutch patients, who were born before 1979 and started RRT <15 years of age between 1972 and 1992. We collected data on mortality and causes of death over the period 2000-10 and compared them with the previously gathered data over the period 1972-99.

RESULTS:

The median duration of follow-up from the start of RRT was 25.5 (range 0.3-39.0 years). Overall, 97 patients died of whom 34 in 2000-10. The overall mortality rate and mortality rate ratios (MRRs) stabilized over time. The MRR for cardiovascular death decreased from 660 in 1972-89 to 70 in 1990-99 and to 20 in 2000-10. Conversely, the MRR for infectious death showed a U-shape; it decreased from 503 in 1972-89 to 102 in 1990-99 and increased again to 350 in 2000-10. In 2000-10, infections became the most prevalent cause of death (44%). In 2000-10, the cardiovascular mortality had decreased with 91% since 1972-89 [adjusted hazard ratio (HR): 0.09, 95% confidence interval (95% CI): 0.02-0.45, P = 0.003], while infectious mortality had doubled over time, although not significantly (adjusted HR: 2.12, 95% CI: 0.88-5.11, P = 0.09).

CONCLUSIONS:

Over the last decade, we found a substantial shift from cardiovascular disease to infections as the main cause of death at long-term follow-up in patients with chronic kidney disease since childhood and who were born before 1979.

KEYWORDS:

cardiovascular disease; infections; long-term follow-up; renal replacement therapy

PMID:
23468535
DOI:
10.1093/ndt/gft048
[Indexed for MEDLINE]

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