Patients undergoing kidney dialysis who have a myocardial infarction have high rates of cardiovascular-related deaths and poor long-term survival, according to a new study in The New England Journal of Medicine (1998;339:799-805).
However, kidney transplant recipients who had a heart attack had far lower mortality rates than the dialysis patients. Following their myocardial infarctions, patients on long-term dialysis had almost three times the risk of overall mortality and four and a half times the risk of cardiovascular-related death compared to renal transplant patients, Charles A. Herzog, MD, and colleagues at the University of Minnesota and Hennepin County Medical Center in Minneapolis reported.
The investigators studied more than 34,000 patients on long-term dialysis who were hospitalized sometime from 1977 through 1995 for a first myocardial infarction. The study included more than 3,000 kidney recipients with acute myocardial infarction. The overall mortality after acute myocardial infarction was 59% and 24% at one year in dialysis patients and transplant recipients, respectively; 73% and 30% at two years; and 90% and 47% at five years. The mortality related to cardiac causes was 41% and 10% at one year in dialysis patients and transplant recipients, respectively; 52% and 11% at two years; and 70% and 19% at five years.
Although patients with endstage renal disease are usually evaluated for the risk of cardiac events only when they are being considered for a kidney transplant, the authors suggested "that an evaluation for cardiac risk be considered for such patients at the initiation of dialysis."
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