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A comparison of the risk of acute myocardial infarction in patients receiving hemodialysis and peritoneal dialysis: A population-based, propensity score-matched cohort study

  • Chien-Yao Sun
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Chung-Yi Li
    Affiliations
    Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan

    Department of Public Health, College of Public Health, China Medical University, Taichung, Taiwan

    Department of Healthcare Administration, College of Medical and Health Science, Asia University, Taichung, Taiwan
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  • Junne-Ming Sung
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Ya-Yun Cheng
    Affiliations
    Department of Environmental and Occupational Health, National Cheng Kung University Hospital, Tainan, Taiwan
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  • Jia-Ling Wu
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan

    Department of Public Health, National Cheng Kung University, College of Medicine, Tainan, Taiwan
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  • Yi-Ting Kuo
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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  • Yu-Tzu Chang
    Correspondence
    Corresponding author. Division of Nephrology, Department of Internal Medicine, National Cheng Kung University Hospital, 138 Sheng-Li Rd., Tainan, 70428, Taiwan.
    Affiliations
    Department of Internal Medicine, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan, Taiwan
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      Highlights

      • Hemodialysis (HD) patients have higher risk of acute myocardial infarction (AMI) than peritoneal dialysis (PD) patients.
      • Risk differences of AMI between HD and PD increased substantially after 4 years since dialysis initiation.
      • Preventive and surveillance programs for AMI should be customized by dialysis modalities, vintage, and risk factors.

      Abstract

      Background and aims

      Acute myocardial infarction (AMI) remains the major cause of morbidity and mortality in the dialysis population. Traditional cardiovascular (CV) risk factors are unable to fully account for the high incidence of AMI in the dialysis population. In this study, we investigated whether dialysis modalities could be one of the uremia-specific risk factors for AMI.

      Methods

      Using the National Health Insurance Research Database, we recruited all incident dialysis patients from the period January 1, 1998 to December 31, 2010. The propensity score matching method was applied to form the matched pairs of hemodialysis (HD) and peritoneal dialysis (PD) patients. Incidence rate (IR), cumulative incidence rate (CIR) and multivariable subdistribution hazards models were employed to compare the risk of AMI in the HD and PD groups.

      Results

      Of the 86,215 incident dialysis patients, 5,513 matched pairs of HD and PD patients were identified. The HD patients had a higher IR of AMI than the PD patients (9.71 vs. 8.35 per 1000 patient-years, respectively, p = 0.01). The CIR was also higher in the HD patients than in the PD patients (0.09 vs. 0.05), especially 4 years after dialysis therapy was initiated (p = 0.04). In the subdistribution hazards models, HD was still significantly associated with a higher risk of developing AMI (adjusted hazard ratio:1.30, 95% confidence interval:1.02–1.65). The results remained unchanged in various stratifications as well as in the analysis of the unmatched cohorts.

      Conclusions

      Compared to PD, HD was significantly associated with higher risk of developing AMI, especially after 4 years since dialysis was initiated. Prevention and routine surveillance programs for AMI should be individualized according to dialysis modalities and vintage.

      Graphical abstract

      Keywords

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