Cardiac Mortality in Chronic Kidney Disease: A Clearer Perspective

Cardiovascular disease remains public health enemy number one. Efforts to reduce deaths from coronary artery disease have generally taken two routes: prevention and treatment. The prevention route aims to identify and manage, when possible, persons who have risk factors for the processes that obstruct the coronary lifelines. The treatment route focuses on the development of strategies to salvage jeopardized myocardium through reperfusion, which, in turn, reduces the short- and long-term morbidity and mortality from coronary thrombosis. In this issue, two articles address both routes, emphasizing the role of impaired kidney function as a risk factor for heart attack and indicating that clinicians underuse available treatments in patients presenting with acute myocardial infarction and impaired kidney function (1, 2).

With the passage of Public Law 92-603 in 1972, Congress extended health care benefits to patients dying of kidney failure, thereby enabling them to receive dialysis. The federal payment reporting system for dialysis care allowed the capture of a wide range of demographic and health-related data in patients receiving benefits for end-stage renal disease (ESRD). The U.S. Renal Data System (USRDS) publishes these data regularly and monitors causes of kidney failure, patient survival, and a host of other data. Particularly germane in the USRDS yearly reports are the morbidity and mortality statistics, with specific cause of death. These data show a remarkably high incidence of heart disease and reveal a striking loss of life from heart disease, especially in the first year of dialysis care. Herzog and colleagues (3) used information from the USRDS database to identify approximately 34 000 patients receiving dialysis who experienced …