E O’LONE1,2,3, N DE LA MATA1, PJ KELLY1, B ROSALES1, P MASSON1,4, AC WEBSTER1,2,5.
1Sydney School of Public Health University of Sydney, Sydney, NSW; 2Centre for Kidney Research, The Children’s Hospital at Westmead, Sydney, NSW; 3Royal North Shore Hospital, Sydney, NSW; 4Department of Renal Medicine, Royal Free Hospital, London, UK; 5Centre for Renal and Transplant Research, Westmead Hospital, Sydney, NSW.
Aim: To determine the relative and absolute risk of death from ischaemic heart disease (IHD) for people with End Stage Kidney Disease (ESKD)
Background: IHD is an important predictor of mortality for people with ESKD. Therapies for reducing cardiovascular risk and treatment of IHD events may be less effective in people with ESKD. The epidemiology of cardiac mortality in the ESKD population compared to the general population is not clear.
Methods: We included incident people with ESKD in Australia and New Zealand 1980-2013. ANZDATA was linked with Australian and New Zealand death registries to obtain cause of death. Summary data for cause specific death in the general population were obtained. We calculated mortality rates for IHD and standardised mortality ratios (SMR) compared to the general population using indirect standardisation by age, sex and calendar year.
Results: There were 58,241 participants contributing 259,935 years of observation time. In total there were 5946 IHD deaths. IHD mortality rates were higher in men (2560 per 100,000 95%CI 2481-2642) than women (1910 per 100,000 95%CI 1830-1994) and rates in both genders increased with age. However, the relative rate was higher in women (SMR 12.5, 95%CI 12.0-13.1) compared to men (SMR 7.5, 95%CI 7.2-7.7). Young women were particularly affected, with those aged 30-49 having a rate over 100 times that of the general population (women SMR 101.5, 95%CI 87.0-118.4; men SMR 25.7, 95%CI 22.9-28.9).
Conclusions: The mortality rates of IHD in the Australian and New Zealand ESKD population are substantially higher than the general population. In particular, young women with ESKD have an excessive relative risk of dying from IHD compared to the general population.