Association Between Vascular Access Dysfunction and Subsequent Major Adverse Cardiovascular Events in XXXX on Hemodialysis: A Population-Based Nested Case-Control Study.

@entity1 @entity409
UNASSIGNED: The association between dialysis vascular @entity409 and the risk of developing major adverse cardiovascular events (MACE) in hemodialysis @entity1 is unclear and has not yet been investigated. We analyzed data from the National Health Insurance Research Database of Taiwan to quantify this association. Adopting a case-control design nested within a cohort of @entity1 who received hemodialysis from 2001 to 2010, we identified 9711 incident cases of MACE during the stage of stable maintenance dialysis and 19,422 randomly selected controls matched to cases on age, gender, and duration of dialysis. Events of vascular @entity409 in the 6-month period before the date of MACE onset (ie, index date) for cases and before index dates for controls were evaluated retrospectively. The presence of vascular @entity409 was associated with a 1.385-fold higher odds of developing MACE as estimated from the logistic regression analysis. This represents a significantly increased adjusted odds ratio (OR) at 1.268 (95% confidence interval [CI]=1.186-1.355) after adjustment for comorbidities and calendar years of initiating dialysis. We also noted a significant exposure-response trend (P<0.001) between the frequency of vascular @entity409 and MACE, with the greatest risk (adjusted OR=1.840, 95% CI=1.549-2.186) noted in @entity1 with >= 3 vascular access events. We concluded that dialysis vascular @entity409 was significantly associated with an increased risk of MACE. Hence, vascular access failure can be an early sign for MACE in @entity1 receiving maintenance hemodialysis. Active monitoring and treatment of cardiovascular risk factors and related diseases, not merely managing vascular @entity409 , would be required to reduce the risk of MACE.
