Risk of cardiovascular events following hemodialysis initiation: a self-controlled case series study

Background: Patients with chronic kidney disease (CKD) are at high risk for cardiovascular disease (CVD). We aimed to evaluate whether hemodialysis (HD) initiation is associated with CVD risk in patients with CKD.

Methods: This self-controlled case series, using data from a nationwide Korean health claims database, included patients with CKD who initiated HD between 2007 and 2019 and experienced CVD, including acute stroke or myocardial infarction (MI), between 2008 and 2020. The risk periods were categorized relative to HD initiation (-60 to -31, -30 to -11, -10 to -1, +1 to +10, +11 to +30, +31 to +60, and +61 to +150 days); the remaining period was set as baseline. The age-adjusted incidence rate ratio (IRR) of CVD in each risk period relative to the baseline was calculated.

Results: Of the 74,584 patients with CKD on incident HD, 12,875 patients with CVD (6,367 with ischemic stroke, 2,396 with hemorrhagic stroke, and 4,112 with MI) were included. Compared with the baseline period, the risk of CVD increased in the post-dialysis periods, decreasing with time since HD initiation; the adjusted IRR during the first 10 days after HD initiation was 2.95 (95% confidence interval, 2.44-3.56). Although the risks of ischemic stroke and MI decreased at 1 to 2 months after HD initiation, the hemorrhagic stroke risk was higher for 5 months.

Conclusion: After HD initiation, the CVD risk increases in patients with CKD. For CVD prevention, the CVD risk should be carefully evaluated in patients with CKD who require HD.