Meeting News

RA not a risk factor for CV mortality in ESRD

Sunita Paudyal

DESTIN, Fla. — Rheumatoid arthritis is not an independent risk factor for cardiovascular mortality in end stage renal disease, according to findings presented that the 2018 North American Young Rheumatology Investigator Forum.

“There is evidence that prevalence of rheumatoid arthritis (RA) and end stage renal disease (ESRD) are rising, as patients are living longer and we are managing them better,” Sunita Paudyal, MBBS, of the University of South Carolina School of Medicine, told attendees. “We will see patients with both of these comorbidities present together in the future. We already know that RA has a major cardiovascular burden, as well as a mortality burden; ESRD also attributes a major cardiovascular disease burden and a mortality burden. However, the impact of RA in the ESRD setting, relative to the burden of cardiovascular disease, all-cause mortality and cardiovascular mortality is unknown.”

To determine whether RA is a risk factor for cardiovascular disease events, or a risk factor in all-cause and cardiovascular mortality in ESRD, Paudyal and colleagues conducted a prospective cohort study of 2,824 adult patients in the United States Renal Data System. Among the participants, 407 had RA while 2,117 were a random 5% sample of individuals in the claims data system without RA.

The researchers noted cardiovascular disease events, as well as all-cause and cardiovascular mortality, in all participants; they then compared data between the two groups using Cox Proportional Hazards modeling.

According to the researchers, 76.4% of participants with RA experienced cardiovascular disease events, compared to 80.1% among the healthy control group (P = .09). In addition, in their adjusted models, Paudyal and colleagues found that RA was not associated with an increased risk for all-cause (aHR = 1.09; 95% CI, 0.94-1.27) or cardiovascular (aHR = 1.11; 95% CI, 0.95-1.29) mortality within 5 years.

Risk factors identified for both all-cause and cardiovascular mortality among patients with RA included older age, higher Charlson comorbidity index, tobacco use and requiring assistance with daily activities. Black and Hispanic ethnicity were associated with significantly less all-cause and cardiovascular mortality, Paudyal said.

“Reviewing our data, our question was, ‘What is going on here?’” Paudyal said. “This is very much in contrast to previous reports suggesting higher overall mortality in patients with RA than in the general population. We also know that in patients with ESRD, cardiovascular disease is the leading cause of mortality, with more than 50% of death attributed to it. Taken together, our study suggests that RA is not an independent risk factor for mortality in ESRD, and that ESRD perhaps exerts a much more significant effect on mortality than RA. I think our data is just the tip of the iceberg, and that there is much more information in the renal data system, and larger-scale studies are needed.” – by Jason Laday

Reference:
Paudyal S. Rheumatoid arthritis is not a risk factor for mortality in end stage renal disease. Presented at: North American Young Rheumatology Investigator Forum; May 16, 2018; Destin, Fla.

Disclosure: Paudyal reports no relevant financial disclosures.

Sunita Paudyal

DESTIN, Fla. — Rheumatoid arthritis is not an independent risk factor for cardiovascular mortality in end stage renal disease, according to findings presented that the 2018 North American Young Rheumatology Investigator Forum.

“There is evidence that prevalence of rheumatoid arthritis (RA) and end stage renal disease (ESRD) are rising, as patients are living longer and we are managing them better,” Sunita Paudyal, MBBS, of the University of South Carolina School of Medicine, told attendees. “We will see patients with both of these comorbidities present together in the future. We already know that RA has a major cardiovascular burden, as well as a mortality burden; ESRD also attributes a major cardiovascular disease burden and a mortality burden. However, the impact of RA in the ESRD setting, relative to the burden of cardiovascular disease, all-cause mortality and cardiovascular mortality is unknown.”

To determine whether RA is a risk factor for cardiovascular disease events, or a risk factor in all-cause and cardiovascular mortality in ESRD, Paudyal and colleagues conducted a prospective cohort study of 2,824 adult patients in the United States Renal Data System. Among the participants, 407 had RA while 2,117 were a random 5% sample of individuals in the claims data system without RA.

The researchers noted cardiovascular disease events, as well as all-cause and cardiovascular mortality, in all participants; they then compared data between the two groups using Cox Proportional Hazards modeling.

According to the researchers, 76.4% of participants with RA experienced cardiovascular disease events, compared to 80.1% among the healthy control group (P = .09). In addition, in their adjusted models, Paudyal and colleagues found that RA was not associated with an increased risk for all-cause (aHR = 1.09; 95% CI, 0.94-1.27) or cardiovascular (aHR = 1.11; 95% CI, 0.95-1.29) mortality within 5 years.

Risk factors identified for both all-cause and cardiovascular mortality among patients with RA included older age, higher Charlson comorbidity index, tobacco use and requiring assistance with daily activities. Black and Hispanic ethnicity were associated with significantly less all-cause and cardiovascular mortality, Paudyal said.

“Reviewing our data, our question was, ‘What is going on here?’” Paudyal said. “This is very much in contrast to previous reports suggesting higher overall mortality in patients with RA than in the general population. We also know that in patients with ESRD, cardiovascular disease is the leading cause of mortality, with more than 50% of death attributed to it. Taken together, our study suggests that RA is not an independent risk factor for mortality in ESRD, and that ESRD perhaps exerts a much more significant effect on mortality than RA. I think our data is just the tip of the iceberg, and that there is much more information in the renal data system, and larger-scale studies are needed.” – by Jason Laday

Reference:
Paudyal S. Rheumatoid arthritis is not a risk factor for mortality in end stage renal disease. Presented at: North American Young Rheumatology Investigator Forum; May 16, 2018; Destin, Fla.

Disclosure: Paudyal reports no relevant financial disclosures.

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