How can the cardiac death rate be reduced in dialysis patients?
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Of 2398 patients on a waiting list for aorto-coronary bypass operation 42 (1.8%) died before operation during an average waiting time of four months. Comparing the diagnostic data of those who died on the waiting list and those after operation, there was an increased frequency of indicators to further progression of the coronary heart disease (angina at rest, three-vessel disease, main stem stenosis, left ventricular contraction abnormalities) in the group of those patients who had died on the waiting list. The significance of these various indicators was further high-lighted in their prognostic significance when taking into account different waiting periods of the various sub-groups.
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Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
Explore the source record for details and available documents.
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Many factors have probably contributed to the observed decline in mortality from coronary disease in the United States since 1968. The issue of whether the incidence of such disease is declining remains to be clarified. The efficacy of primary prevention of coronary artery disease by multiple risk factor modification has been tested in large-scale clinical trials. Among middle-aged, normotensive, hypercholesterolemic smokers, smoking cessation and reduction of cholesterol levels by dietary change are followed by a decreased incidence of coronary events. Groups at high risk because of the combination of hypertension, cigarette smoking, and hypercholesterolemia show reduced coronary disease mortality after drug treatment of hypertension combined with cessation or reduction of cigarette smoking and dietary reduction of cholesterol levels. Primary prevention may be more effective if efforts begin early in life before behaviors and physiologic characteristics that may increase risk become established.
This study evaluates risk factors among commonly measured laboratory values and clinical findings in haemodialysis patients, followed by attempts to identify optimal treatment strategies. Average plasma concentrations of albumin, protein, CO2, urea and creatinine, and average values of systolic and diastolic blood pressure, together with information on gender, age and renal diagnosis, were related to survival rate in 210 sequences of haemodialysis treatment during a period of 94 months. The average treatment time was 12.6 months (range 1-94). The material was analysed with stepwise regression analysis using the Cox proportional hazard model (BMDP 2L), and actuarial life table analysis was performed to illustrate the magnitude of influence of the independent variables on patient survival (BMDP IL). Patient survival was negatively correlated with age and positively correlated with average plasma concentrations of albumin. Surprisingly, patient survival was negatively correlated with plasma CO2. Patient survival was significantly lower in diabetics.
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