Non-Traditional Risk Factors Predict Atherosclerotic Events in Haemodialysis Patients - Post-Hoc Analyses of the AURORA Trial

Background: Patients on haemodialysis are at high risk for cardiovascular events, but heart failure and sudden death dominate and atherosclerotic events are less common. The AURORA trial was designed to assess the effect of rosuvastatin on myocardial infarction and death from any cardiac cause in haemodialysis patients. We studied predictors of the atherosclerotic, and not all cardiovascular, events in AURORA. Methods: We readjudicated all deaths and presumed myocardial infarctions according to stricter criteria to separate atherosclerotic from non‐atherosclerotic cardiovascular events. The readjudicated atherosclerotic endpoint included non‐fatal myocardial infarction, fatal coronary heart disease, non‐fatal and fatal non‐haemorrhagic stroke, revascularisation procedures and death from ischaemic limb disease. Baseline predictors were assessed for the 2776 participants of the AURORA trial, and step‐wise Cox regression analysis was applied. Results: During a mean follow‐up of 3.2 years, 716 patients experienced a readjudicated atherosclerotic event. Baseline phosphate (HR 1.33; 95% CI 1.16‐1.53 per 1 mmol/L increase), albumin (HR 0.93; 95% CI 0.91‐0.96 per 1g/L increase) and high sensitive CRP (HR 1.07; 95% CI 1.00‐1.14 per mg/L increase) were significant predictors in addition to female sex, age, prevalent diabetes and cardiovascular disease. LDL cholesterol was not a significant risk factor. Conclusions: Even with the use of strict criteria for endpoint definition, non‐traditional risk factors, but not lipid disturbances, predicted atherosclerotic events in haemodialysis patients.