Cardiovascular outcomes reported in hemodialysis trials

Authors

Emma O'Lone, The University of Sydney, Sydney, New South Wales, Australia
Andrea K. Viecelli, Princess Alexandra Hospital, Brisbane, Queensland, Australia
Jonathan C. Craig, The University of Sydney, Sydney, New South Wales, Australia
Allison Tong, The University of Sydney, Sydney, New South Wales, Australia
Benedicte Sautenet, University Francois Rabelais, Tours, France
David Roy, St. Vincent's Hospital, Sydney, New South Wales, Australia
William G. Herrington, University of Oxford, Oxford, United Kingdom
Charles A. Herzog, Hennepin County Medical Center/University of Minnesota, Minneapolis, Minnesota
Tazeen Jafar, Aga Khan UniversityFollow
Meg Jardine, The George Institute for Global Health, Sydney, New South Wales, Australia

Document Type

Article

Department

Department of Medicine; Internal Medicine; Nephrology

Abstract

Patients on long-term hemodialysis are at very high risk for cardiovascular disease but are usually excluded from clinical trials conducted in the general population or in at-risk populations. There are no universally agreed cardiovascular outcomes for trials conducted specifically in the hemodialysis population. In this review, we highlight that trials reporting cardiovascular outcomes in hemodialysis patients are usually of short duration (median 3 to 6 months) and are small (59% of trials have <100 participants). Overall, the cardiovascular outcomes are very heterogeneous and may not reflect outcomes that are meaningful to patients and clinicians in supporting decision making, as they are often surrogates of uncertain clinical importance. Composite outcomes used in different trials rarely share the same components. In a field in which a single trial is often insufficiently powered to fully assess the clinical and economic impact of interventions, differences in outcome reporting across trials make the task of meta-analysis and interpretation of all the available evidence challenging. Core outcome sets are now being established across many specialties in health care to prevent these problems. Through the global Standardized Outcomes in Nephrology-Hemodialysis initiative, cardiovascular disease was identified as a critically important core domain to be reported in all trials in hemodialysis. Informed by the current state of reporting of cardiovascular outcomes, a core outcome measure for cardiovascular disease is currently being established with involvement of patients, caregivers, and health professionals. Consistent reporting of cardiovascular outcomes that are critically important to hemodialysis patients and clinicians will strengthen the evidence base to inform care in this very high-risk population.

Comments

Author copy

Publication (Name of Journal)

Journal of the American College of Cardiology

Recommended Citation

O'Lone, E., Viecelli, A. K., Craig, J. C., Tong, A., Sautenet, B., Roy, D., Herrington, W. G., Herzog, C. A., Jafar, T., Jardine, M. (2018). Cardiovascular outcomes reported in hemodialysis trials. Journal of the American College of Cardiology, 71(24), 2802-2810.
Available at: https://ecommons.aku.edu/pakistan_fhs_mc_med_nephrol/67