Rheumatoid Arthritis Increases Risk For Cardiovascular, All-Cause Mortality in End-Stage Renal Disease

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Patients with RA had a much shorter mean time from start of dialysis to any incident CVD event.
Patients with RA had a much shorter mean time from start of dialysis to any incident CVD event.

Patients with rheumatoid arthritis (RA) and end-stage renal disease (ESRD) have an increased risk for cardiovascular-related and all-cause mortality compared with the general population of patients with ERSD, according to research presented at the Annual European Congress of Rheumatology (EULAR) meeting, held June 14-17, in Madrid, Spain.

Researchers from the University of South Carolina in Columbia, the Medical College of Georgia at Augusta University, and the Charlie Norwood Veterans Affairs Medical Center in Augusta conducted a retrospective cohort study of patients with ESRD who began receiving renal replacement therapy (hemodialysis or peritoneal dialysis) between 2005 and 2008. The patients were followed up for 5 years. Outcomes included rates of incident cardiovascular events, cardiovascular-related mortality, and all cause-mortality in patients with RA compared with patients without RA.

A total of 2824 participants were included in the study: 407 with RA and 2417 without RA. There was no significant difference according to RA status in the number of incident cardiovascular disease (CVD) events (with RA, 76.4% vs without RA, 80.1%; P =.09). CVD-related death occurred in 18.7% of patients with RA compared with 16.7% of patients without RA (P =.32). However, all-cause mortality was significantly higher in patients with RA vs patients without RA — 55.5% vs 40.1% (P <.01).

In addition, patients with RA had a much shorter mean time from start of dialysis to any incident CVD event (17.5 vs 21.2 months; P <.01), CVD death (34.2 vs 37.9; P =.02), or all-cause mortality (33.1 vs 37.8; P <.01).

RA was associated with an increased risk for both CVD-related death and all-cause mortality in the final adjusted models (adjusted hazard ratio, 1.23; 95% CI, 1.05-1.43 and adjusted hazard ratio, 1.22; 95% CI, 1.05-1.42, respectively) within 5 years.

Older age, higher Charlson comorbidity index, tobacco use, needing assistance with daily activities, and residing in a nursing home were all considered risk factors for CVD-related and all-cause mortality. Of note, black race and Hispanic ethnicity were associated with significantly less CVD-related and all-cause mortality.

“Physicians treating patients with RA and ESRD should be aware that these patients are at an increased risk for [CVD]-related mortality and all-cause mortality compared with the general population of [patients with] ESRD,” the researchers concluded.

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Reference

Paudyal S, Waller J, Oliver A, et al. Mortality in patients with rheumatoid arthritis and end-stage renal disease. Presented at: EULAR: 2017 Annual European Congress of Rheumatology; June 14-17, 2017; Madrid, Spain. doi:10.1136/annrheumdis-2017-eular.1152

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