Venous Thromboembolism Risk Elevated in Dialysis Patients

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VTE is more common among dialysis patients than in the general population, and the risk is highest in the first 6 months after dialysis initiation.
VTE is more common among dialysis patients than in the general population, and the risk is highest in the first 6 months after dialysis initiation.

Dialysis patients are at increased risk of venous thromboembolism (VTE), and the condition is associated with a greater likelihood of bleeding and all-cause mortality, Canadian researchers reported.

In a population-based retrospective cohort study, Amber O. Molnar, MD, MSc, of McMaster University in Hamilton, Ontario, and colleagues compared 13,315 adult incident dialysis patients who were matched by age and sex to 53,260 individuals in the general population. VTE developed in 1114 (8.4%) of the dialysis patients in the 3 years following dialysis initiation, according to a paper published online in Nephrology Dialysis Transplantation. Patients were at greatest risk for VTE within the 6 months following dialysis initiation. By comparison, VTE developed in 1233 (2.3%) individuals in the general population. Dialysis patients had a 2.9-fold increased risk of VTE compared with the general population in adjusted analyses. Both components of VTE—pulmonary embolism and deep venous thrombosis—developed more frequently in dialysis patients.

In adjusted analyses, dialysis patients with VTE had a 2.0-fold and 2.4-fold higher risk of bleeding and all-cause mortality, respectively, compared with those who did not have VTE.

Dr Molnar's team found that patients whose initial dialysis modality was peritoneal dialysis (PD) versus hemodialysis (HD) had a 29% lower risk of VTE. In addition, VTE risk was higher among patients using a central venous catheter than those who had an arteriovenous fistula or graft or who were on PD.

Of the 1114 dialysis patients who experienced VTE, 192 (17.2%) had a recurrent event more than 1 year following the initial VTE. Compared with dialysis patients who did not have a VTE, those who did had a 2.0- and 2.4-fold greater risk of major bleeding and all-cause mortality, respectively.

The authors concluded that their data “highlight the high risk of VTE among incident dialysis patients, in particular during the first 6 months following dialysis initiation and among patients initiating HD with a catheter.”

Reference

Molnar AO, Bota SE, McArthur E, et al. Risk and complications of venous thromboembolism in dialysis patients. Nephrol Dial Transplant 2017; published online ahead of print.

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