While patients with rheumatoid arthritis (RA) who develop end stage renal disease (ESRD) experience cardiovascular disease (CVD) events sooner than patients without RA, RA is not an independent risk factor for all-cause or cardiovascular (CV) mortality, according to study results published in the Journal of Clinical Rheumatology.
The study included adults with ESRD from the United States Renal Data System (USRDS) with RA and a 5% random sample of people without RA. The researchers used Cox proportional hazards modeling to determine the difference between CVD events, all-cause mortality, and CV mortality in participants with RA and participants without RA.
The study included 407 participants with RA and 2417 without RA. Follow-up lasted up to 5 years depending on mortality and initiation of dialysis.
The researchers did not find any significant differences in the occurrence of CVD events between the groups, with 76.4% (n=311) of participants with RA reporting a CVD event compared with 80.1% (n=1936) of participants without RA. Researchers determined that the participants with RA had a significantly shorter mean time in months from the start of dialysis to an incident CVD event compared with participants without RA (20.1±12.2 vs 21.2±14.1, P <.01).
After adjusting for variables, the results did not indicate that RA was associated with an increased risk for:
- all-cause mortality (adjusted hazard ratio [aHR], 1.09; 95% CI, 0.94-1.27) or
- cardiovascular mortality (aHR, 0.95; 95% CI, 0.74-1.22).
The researchers identified several risk factors for all-cause and CV mortality in participants with RA, including older age and a higher Charlson comorbidity index.
“Despite that cardiac risk factors including hypertension, hyperlipidemia and tobacco use were more common in patients with RA prior to the development of ESRD than the general population who developed ESRD, this did not translate into an increased risk for either all-cause mortality or cardiac-related death when ESRD developed,” the researchers wrote.
Paudyal S, Waller JL, Oliver A, et al. Rheumatoid arthritis and mortality in end stage renal disease [published online December 5, 2018]. J Clin Rheumatol. doi: 10.1097/RHU.0000000000000916