Hospitalizations for valvular heart disease in chronic dialysis patients in the United States.

摘要

Background: Valvular heart disease has not been studied in a national population of end stage renal disease patients. Methods: 327,993 dialysis patients in the United States Renal Data System initiated from 1 January 1992 to 30 June 1997 were analyzed in a historical cohort study of patients hospitalized for valvular heart disease (ICD9 Code 424.x, excluding endocarditis, and 394.x-397.x). Results: 2,778 dialysis patients were hospitalized for VHD (incidence rate, 3.57 per 1,000 person years), and dialysis patients had an age-adjusted incidence ratio for valvular heart disease of 5.06 (95% confidence interval, 4.00-6.42) compared to the general population in 1996. In Cox regression analysis, time to hospitalization for valvular heart disease was associated with earlier year of first dialysis, increased age, congestive heart failure and use of erythropoietin prior to dialysis, while African-American race (AHR 0.62, 0.52-0.74) was associated with decreased risk of hospitalization for valvular heart disease. Patients hospitalized for valvular heart disease had increased mortality compared to all other dialysis patients (adjusted hazard ratio by Cox regression 1.35, 95% CI, 1.25-1.46). Conclusions: Dialysis patients were at increased risk for hospitalizations for valvular heart disease compared to the general population, which substantially decreased patient survival. The reasons for the decreased risk of African-Americans on chronic dialysis for this complication should be the subject of future trials.