Clinicians should be aware that patients with rheumatoid arthritis (RA) who develop end-stage renal disease (ESRD) are at risk of experiencing cardiac events sooner than patients in the general population, although RA is not an independent risk factor for all-cause or cardiovascular mortality in ESRD. This is according to findings published in the Journal of Clinical Rheumatology.
Using Cox proportional hazards modeling, this cohort study was designed to characterize cardiovascular disease (CVD) events, cardiovascular mortality, and all-cause mortality in patients with RA and ESRD compared with those with ESRD without RA. Data from 48,005 patients were obtained from the United States Renal Database System (USRDS). The study sample included 407 patients with ESRD and RA and a random sample of 5% (n=2417) of patients with ESRD without RA. The study duration spanned up to 5 years, depending on initiation of dialysis and mortality.
Heart failure was the most common CVD event among participants both with and without RA (47.4% and 27.8%, respectively). Compared with those without RA, patients with RA showed a significantly shorter mean time from start of dialysis to an incident CVD event (20.1±12.2 months vs 21.2±14.1 months; P <.01). No significant differences in total incident CVD events were seen by RA status (P =.09) or individual CVD events (P ≥.11) besides atherosclerosis and heart failure, which were significantly more prevalent in participants without RA (P <.01 for both). Multivariable adjusted models showed that RA was not associated with increased 5-year 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). In patients with RA, risk factors for all-cause and cardiovascular mortality included older age and a higher Charlson comorbidity index.
Study investigators concluded that “time to first cardiac event is shorter in patients with RA and ESRD compared with the general population of patients with ESRD. However, in patients with ESRD, RA is not an independent risk factor for either all-cause or cardiovascular mortality.”
Paudyal S, Waller JL, Oliver A, et al. Rheumatoid arthritis and mortality in end stage renal disease. J Clin Rheumatol. 2020;26(2):48-53.