Risk Factors Associated with Cardiovascular Morbidity and Mortality in Spanish Incident Hemodialysis Patients: Two-Year Results from the ANSWER Study

Aims: To identify factors associated with cardiovascular (CV) disease in hemodialysis. Methods: Multicenter, prospective, 2-year, observational study in 2,310 incident patients (3,496 patient-years). Multivariate Cox models determined baseline characteristics associated with CV disease. Results: Main factors associated with CV deaths (6.3/100 patient-years) were: high Charlson score (hazard ratio (HR) 3.6; 95% confidence interval (CI) 1.7-7.5 for >= 9 vs. <= 4); low Karnofsky score (KS; HR 2.2; 95% CI 1.5-3.3 for KS <= 50 vs. >70); female gender (HR 1.4; 95% CI 1.1-1.9); catheter access (HR 1.4; 95% CI 1.0-1.9); low (<3.5 g/dl) albumin (HR 2.5; 95% CI 1.8-3.3); ferritin deficiency (HR 1.6; 95% CI 1.2-2.2 for <100 vs. >= 100-500 ng/ml) and low body mass index (BMI; HR 1.9; 95% CI 1.2-3.0 for <20 vs. 20-25). A BMI of >= 30 was a protective factor (HR 0.6; 95% CI 0.4-0.9). Conclusions: There is a high CV risk, especially in older patients with high comorbidity, low BMI, low albumin or iron deficiency. Catheter access increases the CV death risk. Copyright (C) 2011 S. Karger AG, Basel