Download PDF
Thromb Haemost 2011; 106(06): 1046-1052
DOI: 10.1160/TH11-06-0422
Blood Coagulation, Fibrinolysis and Cellular Haemostasis
Schattauer GmbH

Venous and arterial thrombosis in dialysis patients

Gurbey Ocak
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Carla Y. Vossen
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
2   Division of Biomedical Genetics, Department of Medical Genetics, University Medical Center Utrecht, The Netherlands
,
Joris I. Rotmans
3   Department of Nephrology, Leiden University Medical Center, The Netherlands
,
Willem M. Lijfering
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Frits R. Rosendaal
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
4   Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
,
Karien J. Parlevliet
5   Department of Nephrology, Rijnstate hospital, Arnhem, The Netherlands
,
Ray T. Krediet
6   Department of Nephrology, Academic Medical Center, Amsterdam, The Netherlands
,
Els W. Boeschoten
7   Hans Mak Institute, Naarden, The Netherlands
,
Friedo W. Dekker
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
,
Marion Verduijn
1   Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
› Author Affiliations
Further Information

Publication History

Received: 22 June 2011

Accepted after major revision: 13 August 2011

Publication Date:
27 November 2017 (online)

Also available at
    Permissions and Reprints

Summary

Whether the risk of both venous and arterial thrombosis is increased in dialysis patients as compared to the general population is unknown. In addition, it is unknown which subgroups are at highest risk. Fur-thermore, it is unknown whether having a history of venous thrombosis or arterial thrombosis prior to dialysis treatment increases mortality risk. A total of 455 dialysis patients were followed for objectively verified symptomatic thrombotic events between January 1997 and June 2009. The incidence rates in dialysis patients as compared to the general population was 5.6-fold (95% CI 3.1–8.9) increased for venous thrombosis, 11.9-fold (95% CI 9.3–14.9) increased for myocardial infarction, and 8.4-fold (95% CI 5.7–11.5) increased for ischaemic stroke. The combination of haemodialysis, lowest tertile of albumin, history of venous thrombosis, and malignancy was associated with subsequent venous thrombosis. Increased age, renal vascular disease, diabetes, high cholesterol levels, history of venous thrombosis, and history of arterial thrombosis were associated with subsequent arterial thrombosis. The all-cause mortality risk was 1.9-fold (95% CI 1.1–3.3) increased for patients with a history of venous thrombosis and 1.9-fold (95% CI 1.4–2.6) increased for patients with a history of arterial thrombosis. A potential limitation of this study was that in some risk categories as-sociations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elev-ated risks of venous thrombosis and arterial thrombosis and occurrence of venous thrombosis or arterial thrombosis prior to the start of dialysis is associated with an increased mortality risk.

Keywords

Dialysis - venous thrombosis - arterial thrombosis
 

  • References

  • 1 Lowe GD. Common risk factors for both arterial and venous thrombosis. Br J Haematol 2008; 140: 488-495.
    CrossrefPubMedGoogle Scholar
  • 2 Prandoni P, Bilora F, Marchiori A. et al. An association between atherosclerosis and venous thrombosis. N Engl J Med 2003; 348: 1435-1441.
    CrossrefPubMedGoogle Scholar
  • 3 Sørensen HT, Horvath-Puho E, Pedersen L. et al. Venous thromboembolism and subsequent hospitalisation due to acute arterial cardiovascular events: a 20-year cohort study. Lancet 2007; 370: 1773-1779.
    CrossrefPubMedGoogle Scholar
  • 4 Becattini C, Agnelli G, Prandoni P. et al. A prospective study on cardiovascular events after acute pulmonary embolism. Eur Heart J 2005; 26: 77-83.
    CrossrefPubMedGoogle Scholar
  • 5 Klok FA, Mos IC, Broek L. et al. Risk of arterial cardiovascular events in patients after pulmonary embolism. Blood 2009; 114: 1484-1488.
    CrossrefPubMedGoogle Scholar
  • 6 Sorensen HT, Horvath-Puho E, Sogaard SK. et al. Arterial cardiovascular events, statins, low-dose aspirin and subsequent risk of venous thromboembolism: a population-based case-control study. J Thromb Haemost 2009; 7: 521-528.
    CrossrefPubMedGoogle Scholar
  • 7 Holst AG, Jensen G, Prescott E. Risk factors for venous thromboembolism: results from the Copenhagen City Heart Study. Circulation 2010; 121: 1896-1903.
    CrossrefPubMedGoogle Scholar
  • 8 Goldhaber SZ, Grodstein F, Stampfer MJ. et al. A prospective study of risk factors for pulmonary embolism in women. J Am Med Assoc 1997; 277: 642-645.
    CrossrefPubMedGoogle Scholar
  • 9 Tsai AW, Cushman M, Rosamond WD. et al. Cardiovascular risk factors and venous thromboembolism incidence: the longitudinal investigation of thromboembolism etiology. Arch Intern Med 2002; 162: 1182-1189.
    CrossrefPubMedGoogle Scholar
  • 10 Ageno W, Becattini C, Brighton T. et al. Cardiovascular risk factors and venous thromboembolism: a meta-analysis. Circulation 2008; 117: 93-102.
    CrossrefPubMedGoogle Scholar
  • 11 Pomp ER, Rosendaal FR, Doggen CJ. Smoking increases the risk of venous thrombosis and acts synergistically with oral contraceptive use. Am J Hematol 2008; 83: 97-102.
    CrossrefPubMedGoogle Scholar
  • 12 Ocak G, Verduijn M, Vossen CY. et al. Chronic kidney disease stage 1-3 increases risk of venous thrombosis. J Thromb Haemost 2010; 8: 2611-2617.
    PubMedGoogle Scholar
  • 13 Brantsma AH, Bakker SJ, Hillege HL. et al. Cardiovascular and renal outcome in subjects with K/DOQI stage 1-3 chronic kidney disease: the importance of urinary albumin excretion. Nephrol Dial Transplant 2008; 23: 3851-3858.
    CrossrefPubMedGoogle Scholar
  • 14 Trespalacios FC, Taylor AJ, Agodoa LY. et al. Incident acute coronary syndromes in chronic dialysis patients in the United States. Kidney Int 2002; 62: 1799-1805.
    CrossrefPubMedGoogle Scholar
  • 15 de Jager DJ, Grootendorst DC, Jager KJ. et al. Cardiovascular and noncardiovascular mortality among patients starting dialysis. J Am Med Assoc 2009; 302: 1782-1789.
    CrossrefPubMedGoogle Scholar
  • 16 Foley RN, Parfrey PS, Sarnak MJ. Epidemiology of cardiovascular disease in chronic renal disease. J Am Soc Nephrol 1998; 9: S16-S23.
    PubMedGoogle Scholar
  • 17 Foley RN, Parfrey PS, Sarnak MJ. Clinical epidemiology of cardiovascular disease in chronic renal disease. Am J Kidney Dis 1998; 32: S112-S119.
    CrossrefPubMedGoogle Scholar
  • 18 Cheung AK, Sarnak MJ, Yan G. et al. Cardiac diseases in maintenance hemodialysis patients: results of the HEMO Study. Kidney Int 2004; 65: 2380-2389.
    CrossrefPubMedGoogle Scholar
  • 19 Delmez JA, Yan G, Bailey J. et al. Cerebrovascular disease in maintenance hemodialysis patients: results of the HEMO Study. Am J Kidney Dis 2006; 47: 131-138.
    CrossrefPubMedGoogle Scholar
  • 20 Sozio SM, Armstrong PA, Coresh J. et al. Cerebrovascular disease incidence, characteristics, and outcomes in patients initiating dialysis: the choices for healthy outcomes in caring for ESRD (CHOICE) study. Am J Kidney Dis 2009; 54: 468-477.
    CrossrefPubMedGoogle Scholar
  • 21 Tveit DP, Hypolite IO, Hshieh P. et al. Chronic dialysis patients have high risk for pulmonary embolism. Am J Kidney Dis 2002; 39: 1011-1017.
    CrossrefPubMedGoogle Scholar
  • 22 van Dijk PC, Jager KJ, de Charro F. et al. Renal replacement therapy in Europe: the results of a collaborative effort by the ERA-EDTA registry and six national or regional registries. Nephrol Dial Transplant 2001; 16: 1120-1129.
    CrossrefPubMedGoogle Scholar
  • 23 Naess IA, Christiansen SC, Romundstad P. et al. Incidence and mortality of venous thrombosis: a population-based study. J Thromb Haemost 2007; 5: 692-699.
    CrossrefPubMedGoogle Scholar
  • 24 Parikh NI, Gona P, Larson MG. et al. Long-term trends in myocardial infarction incidence and case fatality in the National Heart, Lung, and Blood Institute's Framingham Heart study. Circulation 2009; 119: 1203-1210.
    CrossrefPubMedGoogle Scholar
  • 25 Mohr JP, Choi DW, Grotta JC. et al. In Stroke: Pathophysiology, Diagnosis, and Management. 4th ed Philidelphia: Churchill Livingstone; 2004. p 14
    Google Scholar
  • 26 Verduijn M, Grootendorst DC, Dekker FW. et al. The analysis of competing events like cause-specific mortality--beware of the Kaplan-Meier method. Nephrol Dial Transplant 2010; 26: 56-61.
    PubMedGoogle Scholar
  • 27 Rotter W, Roettger P. Comparative pathologic-anatomic study of cases of chronic global renal insufficiency with and without preceding hemodialysis. Clin Nephrol 1973; 1: 257-265.
    PubMedGoogle Scholar
  • 28 Mossey RT, Kasabian AA, Wilkes BM. et al. PUlmonary embolism Low incidence in chronic renal failure. Arch Intern Med 1982; 142: 1646-1648.
    CrossrefPubMedGoogle Scholar
  • 29 Guntupalli K, Soffer O, Baciewicz P. Pulmonary embolism in end stage renal disease. Intensive Care Med 1990; 16: 405-407.
    CrossrefPubMedGoogle Scholar
  • 30 Wiesholzer M, Kitzwogerer M, Harm F. et al. Prevalence of preterminal pulmonary thromboembolism among patients on maintenance hemodialysis treatment before and after introduction of recombinant erythropoietin. Am J Kidney Dis 1999; 33: 702-708.
    CrossrefPubMedGoogle Scholar
  • 31 Casserly LF, Dember LM. Thrombosis in end-stage renal disease. Semin Dial 2003; 16: 245-256.
    CrossrefPubMedGoogle Scholar
  • 32 Baskin E, Duman O, Besbas N. et al. Hypercoagulopathy in a hemodialysis patient: are elevations in factors VII and VIII effective?. Nephron 1999; 83: 180
    CrossrefPubMedGoogle Scholar
  • 33 Smits HF, Van Rijk PP, Van Isselt JW. et al. Pulmonary embolism after thrombolysis of hemodialysis grafts. J Am Soc Nephrol 1997; 8: 1458-1461.
    PubMedGoogle Scholar
  • 34 Bellomo R, Wood C, Wagner I. et al. Idiopathic membranous nephropathy in an Australian population: the incidence of thromboembolism and its impact on the natural history. Nephron 1993; 63: 240-241.
    CrossrefPubMedGoogle Scholar
  • 35 Mahmoodi BK, ten Kate MK, Waanders F. et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome: results from a large retrospective cohort study. Circulation 2008; 117: 224-230.
    CrossrefPubMedGoogle Scholar
  • 36 Parekh RS, Zhang L, Fivush BA. et al. Incidence of atherosclerosis by race in the dialysis morbidity and mortality study: a sample of the US ESRD population. J Am Soc Nephrol 2005; 16: 1420-1426.
    CrossrefPubMedGoogle Scholar
  • 37 Herzog CA, Ma JZ, Collins AJ. Poor long-term survival after acute myocardial infarction among patients on long-term dialysis. N Engl J Med 1998; 339: 799-805.
    CrossrefPubMedGoogle Scholar
  • 38 Klok FA, Zondag W, van Kralingen KW. et al. Patient outcomes after acute pulmonary embolism. A pooled survival analysis of different adverse events. Am J Respir Crit Care Med 2010; 181: 501-506.
    CrossrefPubMedGoogle Scholar