With the expanding U.S. ESRD population of older patients and those with diabetic nephropathy and their concomitant burden of cardiac disease, it becomes increasingly important to study the impact of cardiovascular morbidity and mortality on the survival of ESRD patients. Past efforts to identify ischemic heart disease in ESRD patients have been predominantly focused on “high risk” renal transplant candidates, who represent a minority of ESRD patients. Despite this burgeoning population of dialysis patients and their burden of ischemic heart disease, there is a surprising paucity of new data on the survival of dialysis patients or renal transplant recipients relative to ischemic heart disease and its complications. In contrast to the general population, patients with end-stage renal disease have not been the focus of studies centering on the prevention, diagnosis, and treatment of cardiac disease. For example, the extraordinary cardiac risk of dialysis patients is exemplified by our recent publication (Herzog CA, Ma JZ, Collins AJ: Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. New England Journal of Medicine 339: 795-805, 1998), utilizing USRDS data, which reported a two-year, 73% mortality among 34,189 dialysis patients hospitalized for acute myocardial infarction in 1977 through 1995. Even more striking was the two-year, 74% mortality in dialysis patients hospitalized from 1990 through 1995, an astoundingly high mortality for patients receiving treatment in the modern era of cardiology.

It is the mission of the USRDS Cardiovascular Special Studies Center to focus attention on the broad topic of cardiovascular disease in patients with end-stage renal disease. Although a major focus of the Cardiovascular Special Studies Center is acute myocardial infarction and coronary revascularization procedures in patients with end-stage renal disease, these are not the sole areas of research interest. The extraordinary risk of cardiovascular disease in patients with ESRD is not restricted to adult patients. No previous research has systematically investigated the burden of cardiovascular disease in pediatric ESRD patients. This burden of cardiac disease is significant in the pediatric ESRD population, as 33% of pediatric ESRD patient deaths are attributed to cardiovascular causes, but the cardiac morbidity and mortality of pediatric ESRD patients is a relatively unexplored area. Even less clear is the therapeutic approach employed in the United States in those pediatric patients who manifest cardiac disease.

The increasing burden of cardiovascular disease in patients with ESRD is a challenging clinical problem with important consequences for the health of individual patients suffering from cardiac disease and for the health care system charged with caring for these patients. Despite the magnitude of the problem, there is a dearth of reliable data on the treatment and survival of adult ESRD patients sustaining AMI or their outcome following coronary revascularization procedures. Pediatric ESRD patients have attracted even less attention in the cardiovascular arena. The mission of the USRDS Cardiovascular Special Studies Center is the design and implementation of studies utilizing the existing USRDS database, and the creation of new special data collection studies, which ultimately will lead to conclusions that may be generalized for the improvement of the health and welfare of patients with end-stage renal disease.