Cardiovascular mortality risk changes during the course of kidney failure (KF) when patients develop concomitant illness and switch treatment regimens. Absolute cardiovascular mortality rates would assist improve clinical practice and healthcare supply, but they are not well characterized throughout a dialysis and transplant state continuum. Using a lifetime approach, researchers intended to characterize cardiovascular mortality across the natural history of KF.

Investigators conducted a population-based cohort analysis of incident patients starting kidney replacement treatment. Data linking to national death records were used to identify cardiovascular fatalities. Using multi-state models, they assessed the likelihood of death and kidney transplantation and determined graft failure rates and cardiovascular mortality across demographic parameters and comorbidities.

Cardiovascular disease accounted for 25% (8,492) of fatalities among 60,823 incident patients tracked over 381,874 person-years. Patients had a 15.2% chance of dying from cardiovascular disease without being transplanted after 15 years, but only a 2.3% chance of dying from cardiovascular disease after transplantation. Females had a 3% lower risk of cardiovascular mortality at 15 years (15.3% vs. 18.6%), but a 4% greater risk of non-cardiovascular death (54.5% vs. 50.8%). Cardiovascular mortality increased in the second month of dialysis and showed no improvement across treatment eras.

Despite progress, cardiovascular mortality remains prevalent in KF, particularly among dialysis patients and during the first few months of therapy. Absolute measurements of cardiovascular mortality throughout dialysis and transplant states can be provided using multi-state models.