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Shiri P, Rezaeian S, Abdi A, Jalilian M, Khatony A. Risk factors for thrombosis in dialysis patients: A comprehensive systematic review and meta-analysis. JOURNAL OF VASCULAR NURSING 2024; 42:165-176. [PMID: 39244328 DOI: 10.1016/j.jvn.2024.05.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/18/2023] [Revised: 05/06/2024] [Accepted: 05/13/2024] [Indexed: 09/09/2024]
Abstract
AIM To identify the factors associated with thrombosis in dialysis patients. BACKGROUND Thrombosis is a leading cause of vascular access failure in dialysis patients. Numerous risk factors contribute to thrombosis in this population. METHODS A systematic search was conducted across international databases using standardized keywords. The quality of the selected studies was assessed using the STROBE and CONSORT checklists. The findings were summarized in a Garrard table. Meta-analysis was performed using CMA software. The study adhered to the guidelines outlined in the PRISMA statement. RESULTS A total of 180 articles were reviewed. The odds ratio for thrombosis in patients with arteriovenous grafts compared to arteriovenous fistulas was 10.93 (95 % CI: 9.35-12.78), demonstrating statistical significance (P = 0.001). Similarly, hemodialysis patients had an odds ratio of thrombosis 3.60 times higher than non-hemodialysis patients (95 % CI: 3.54-4.19), with statistical significance (P = 0.001). Patients undergoing single-stage basilic vein transposition had a 1.89 times higher risk of thrombosis compared to those undergoing two-stage transposition (95 % CI: 1.04-3.46), also demonstrating statistical significance (P = 0.038). CONCLUSIONS Thrombosis in patients with end-stage renal disease undergoing dialysis was significantly associated with various factors, including graft access, single-stage basilic vein transposition, and hemodialysis. Additional contributing factors to thrombosis included diabetes, elevated homocysteine levels, female gender, age over 50, access location, and low access blood flow velocity. The analysis revealed a higher incidence of thrombosis in end-stage renal disease patients undergoing hemodialysis compared to those not undergoing dialysis, as well as in patients with arteriovenous grafts compared to those with arteriovenous fistulas. These findings underscore the importance of recognizing and managing these risk factors to prevent thrombotic events and enhance patient care within the dialysis setting.
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Affiliation(s)
- Parisa Shiri
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Shabab Rezaeian
- Social Development and Health Promotion Research Centre, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Milad Jalilian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Khatony
- Social Development and Health Promotion Research Centre, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran; Infectious Diseases Research Centre, Kermanshah University of Medical Sciences, Kermanshah, Iran.
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Liao YC, Chang CC, Chen CY, Liu CC, Liao CC, Shih YRV, Lin CS. Preoperative renal insufficiency predicts postoperative adverse outcomes in a mixed surgical population: a retrospective matched cohort study using the NSQIP database. Int J Surg 2023; 109:752-759. [PMID: 36974714 PMCID: PMC10389524 DOI: 10.1097/js9.0000000000000278] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/18/2022] [Accepted: 01/27/2023] [Indexed: 03/29/2023]
Abstract
BACKGROUND The incidence of chronic kidney disease is increasing, but most cases are not diagnosed until the accidental finding of abnormal laboratory data or the presentation of severe symptoms. Patients with chronic kidney disease are reported to have an increased risk of postoperative mortality and morbidities, but previous studies mainly targeted populations undergoing cardiovascular surgery. The authors aimed to evaluate the risk of postoperative mortality and complications in a surgical population with preoperative renal insufficiency (RI). MATERIALS AND METHODS This retrospective cohort study used data from the National Surgical Quality Improvement Program database between 2013 and 2018 to evaluate the risk of postoperative morbidity and mortality in the surgical population. Patients with estimated glomerular filtration rate less than 60 ml/min/1.73 m 2 were defined as the RI group. Propensity score matching methods and multivariate logistic regression were used to calculate the risk of postoperative morbidity and mortality. RESULTS After propensity score matching, 502 281 patients were included in the RI and non-RI groups. The RI group had a higher risk of 30-day in-hospital mortality (odds ratio: 1.54, 95% CI: 1.49-1.58) than the non-RI group. The RI group was associated with a higher risk of postoperative complications, including myocardial infarction, stroke, pneumonia, septic shock, and postoperative bleeding. The RI group was also associated with an increased risk of prolonged ventilator use for over 48 h, readmission, and reoperation. CONCLUSION Patients with preoperative RI have an increased risk of postoperative 30-day mortality and complications. RI group patients with current dialysis, estimated glomerular filtration rate less than or equal to 30 ml/min/1.73 m 2 or concomitant anemia had an elevated risk of postoperative mortality.
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Affiliation(s)
| | - Chuen-Chau Chang
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Yu Chen
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chih-Chung Liu
- Department of Anesthesiology
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Chien-Chang Liao
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
| | - Yu-Ru Vernon Shih
- Department of Orthopedic Surgery, Duke University, Durham, North Carolina, USA
| | - Chao-Shun Lin
- Department of Anesthesiology
- Anesthesiology and Health Policy Research Center, Taipei Medical University Hospital
- Department of Anesthesiology, School of Medicine, College of Medicine, Taipei Medical University, Taipei, Taiwan
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3
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Lu HY, Liao KM. Increased risk of deep vein thrombosis in end-stage renal disease patients. BMC Nephrol 2018; 19:204. [PMID: 30115029 PMCID: PMC6097196 DOI: 10.1186/s12882-018-0989-z] [Citation(s) in RCA: 33] [Impact Index Per Article: 5.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/18/2017] [Accepted: 07/20/2018] [Indexed: 02/07/2023] Open
Abstract
Background Previous studies have shown that chronic kidney disease increases the risk of deep vein thrombosis (DVT). DVT is the risk of pulmonary embolism among persons with end-stage renal disease (ESRD). Information on the incidence of DVT in ESRD is limited, and no studies have been conducted in the Asian population. The aim of our study was to investigate the incidence of DVT in Asian ESRD patients by comparing with the non-ESRD patients and to identify the associated risk factors. Methods This study retrieved patients who were diagnosed with ESRD (ICD-9-CM codes 585 or 586) between January 1, 2004, and December 31, 2010, from the National Health Insurance Research Database in Taiwan. All ESRD patients had received a catastrophic illness card from the Ministry of Health and Welfare in Taiwan, with the major illness identified as ESRD. Patients who had DVT before the index date or who had incomplete records were excluded from the analysis. A total of 4865 ESRD patients were enrolled. There are 3564 ESRD patients included after exclusion of patients with previous DVT and patients with incomplete records. The control subjects were randomly selected as the patients without ESRD by matching study subjects according to age (±3 years), gender, and the year of admission at a 2:1 ratio from the same dataset. Results The incidence rate of DVT was substantially higher in the ESRD group than in the without-ESRD group (20.9 vs. 1.46 per 10^4 person-years). The adjusted hazard ratio (aHR 13.92; 95% CI 9.25–20.95) of DVT for the ESRD patients was 13.92 times that for the non-ESRD patients. ESRD patients older than 50 years had a higher risk of DVT (aHR 1.65; 95% CI 1.13–2.40; P = 0.01). Hyperlipidemia was significantly associated with an increased risk of DVT (aHR 1.73; 95% CI 1.08–2.78; P = 0.02). ESRD patients with three or more comorbidities were substantially more likely to have DVT (aHR 1.45; 95% CI 1.03–2.03; P = 0.03). Conclusions ESRD patients had a higher risk of DVT than non-ESRD patients. Among the ESRD patients, being older than 50 years and having dyslipidemia increased the risk of DVT.
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Affiliation(s)
- Hsueh-Yi Lu
- Department of Industrial Engineering and Management, National, Yunlin University of Science and Technology, Yun-Lin, Taiwan
| | - Kuang-Ming Liao
- Department of Internal Medicine, Chi Mei Medical Center, Chiali, Taiwan.
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4
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Gigante A, Di Mario F, Pierucci A, Amoroso A, Pignataro FS, Napoleone L, Basili S, Raparelli V. Kidney disease and venous thromboembolism: Does being woman make the difference? Eur J Intern Med 2017; 39:18-23. [PMID: 28258791 DOI: 10.1016/j.ejim.2017.02.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/26/2016] [Revised: 12/20/2016] [Accepted: 02/16/2017] [Indexed: 01/05/2023]
Abstract
The risk of venous thromboembolism (VTE) is increased across the spectrum of chronic kidney disease (CKD), from mild to more advanced CKD, and typically characterizes nephrotic syndrome (NS). VTE risk in patients with kidney disease may be due to underlying hemostatic abnormalities, including activation of pro-thrombotic factors, inhibition of endogenous anticoagulation systems, enhanced platelet activation and aggregation, and decreased fibrinolytic activity. The mechanisms involved differ depending on the cause of the kidney impairment (i.e. presence of NS or CKD stage). Sex and gender differences, as well as, environmental factors or comorbidities may play a modulating role; however, specific sex and gender data on this topic are still rare. The aim of the present review is to discuss the VTE risk associated with impairment of kidney function, the potential mechanism accounting for it and the impact of sex differences in this clinical setting.
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Affiliation(s)
- A Gigante
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy.
| | - F Di Mario
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Pierucci
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - A Amoroso
- Department of Clinical Medicine, Sapienza University of Rome, Rome, Italy
| | - F S Pignataro
- Department of Internal Medicine and Medical Specialties, Sapienza University of Rome, Rome, Italy
| | - L Napoleone
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
| | - S Basili
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy; Research Center on Gender and Evaluation and Promotion of Quality in Medicine, (CEQUAM), Sapienza University of Rome, Rome, Italy
| | - V Raparelli
- Department of Experimental Medicine, Sapienza University of Rome, Rome, Italy
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5
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Janus N, Mahé I, Launay-Vacher V, Laroche JP, Deray G. Renal function and venous thromboembolic diseases. ACTA ACUST UNITED AC 2016; 41:389-395. [PMID: 28029509 DOI: 10.1016/j.jmv.2016.09.001] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/18/2016] [Accepted: 09/18/2016] [Indexed: 12/31/2022]
Abstract
Anticoagulant agents have been approved by international regulatory agencies to prevent and treat venous thromboembolism (VTE). However, chronic kidney disease (CKD) is: (1) highly frequent in VTE patients; (2) strongly linked to VTE; and (3) a risk factor for cardiovascular morbidity/mortality and fatal pulmonary embolism. Therefore, an increasing number of patients are presented with CKD and VTE and more and more physicians must face the questions of the management of these patients and that of the handling of anticoagulant agents in CKD patients because of the pharmacokinetic modifications of these drugs in this population. These modifications may lead to overdosage and dose-related side effects, such as bleeding. It is therefore necessary to screen VTE patients for CKD and to modify the doses of anticoagulants, if necessary.
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Affiliation(s)
- N Janus
- Service ICAR, Pitié-Salpêtrière university hospital, 83, boulevard de l'Hôpital, 75013 Paris, France; Department of nephrology, Pitié-Salpêtrière hospital, 75013 Paris, France.
| | - I Mahé
- Internal medicine department, Louis-Mourier hospital, 92701 Colombes, France
| | - V Launay-Vacher
- Service ICAR, Pitié-Salpêtrière university hospital, 83, boulevard de l'Hôpital, 75013 Paris, France; Department of nephrology, Pitié-Salpêtrière hospital, 75013 Paris, France
| | - J-P Laroche
- Vascular medicine department, Saint-Eloi hospital, 34000 Montpellier, France
| | - G Deray
- Service ICAR, Pitié-Salpêtrière university hospital, 83, boulevard de l'Hôpital, 75013 Paris, France; Department of nephrology, Pitié-Salpêtrière hospital, 75013 Paris, France
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Altınsoy B, Öz İİ, Örnek T, Erboy F, Tanrıverdi H, Uygur F, Altintas N, Atalay F, Tor MM. Prognostic Value of Renal Dysfunction Indicators in Normotensive Patients With Acute Pulmonary Embolism. Clin Appl Thromb Hemost 2016; 23:554-561. [DOI: 10.1177/1076029616637440] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/18/2023] Open
Abstract
Introduction: Glomerular filtration rate (GFR) and blood urea nitrogen (BUN) are important prognostic indicators for cardiovascular disease. However, data on the relationship between renal dysfunction (RD) and prognosis in patients with acute pulmonary embolism (APE) are limited. The estimated-GFR (eGFR), based on the Modification of Diet in Renal Disease (MDRD) equation, has been suggested as a possible prognostic marker in patients with APE; however, at present, the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation is thought to be more accurate than the MDRD equation for the estimation of RD. Objective: We investigated whether eGFRCKD-EPI or BUN could predict adverse outcomes (AOs) better than eGFRMDRD in normotensive patients with APE. Methods: Ninety-nine normotensive patients with APE (aged 22-96, 56% male) were enrolled in the study retrospectively. Adverse outcomes were defined as the occurrence of any of the following: death, cardiopulmonary resuscitation, use of vasopressors, thrombolysis, or mechanical ventilation. Results: In univariate analyses, age, gender (male), heart rate (>110 bpm), serum creatinine, BUN, cardiac troponin (cTn) positivity, right ventricle–left ventricle ratio, eGFRMDRD, and eGFRCKD-EPI were found to be significantly different between those with and without AOs. Comparing area under the curves for AO, we found statistically significant differences between eGFRCKD-EPI and eGFRMDRD ( P = .01) but not between BUN and eGFRCKD-EPI or BUN and eGFRMDRD. Furthermore, 30-day mortality was 36% versus 11% in cTn-positive patients with an eGFRCKD-EPI < and ≥ 60 mL/min, respectively. Conclusion: There is a close relationship between RD and APE prognosis. We conclude eGFRCKD-EPI is a potential prognostic marker for risk stratification in normotensive patients with APE.
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Affiliation(s)
- Bülent Altınsoy
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - İbrahim İlker Öz
- Department of Radiology, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Tacettin Örnek
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Fatma Erboy
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Hakan Tanrıverdi
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Fırat Uygur
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Nejat Altintas
- Department of Pulmonary Medicine, School of Medicine, Namık Kemal University, Tekirdağ, Turkey
| | - Figen Atalay
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
| | - Müge Meltem Tor
- Department of Pulmonary Medicine, School of Medicine, Bulent Ecevit University, Esenköy, Kozlu, Zonguldak, Turkey
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7
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Ahn S, Kim MH, Jun KW, Hwang JK, Park SC, Moon IS, Kim JI. The incidence and risk factors for deep vein thrombosis after kidney transplantation in Korea: single-center experience. Clin Transplant 2015; 29:1181-6. [DOI: 10.1111/ctr.12648] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 10/04/2015] [Indexed: 01/10/2023]
Affiliation(s)
- Sanghyun Ahn
- Department of Surgery; Yeouido St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Mi-Hyeong Kim
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Kang-Woong Jun
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Jeong-Kye Hwang
- Department of Surgery; Daejeon St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Soon-Chul Park
- Department of Surgery; Uijeongbu St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - In-Sung Moon
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
| | - Ji-Iil Kim
- Department of Surgery; Seoul St. Mary's Hospital; College of Medicine; The Catholic University of Korea; Seoul Korea
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Suttorp MM, Hoekstra T, Ocak G, van Diepen AT, Ott I, Mittelman M, Rabelink TJ, Krediet RT, Dekker FW. Erythropoiesis-stimulating agents and thrombotic events in dialysis patients. Thromb Res 2014; 134:1081-6. [DOI: 10.1016/j.thromres.2014.07.030] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/24/2014] [Revised: 06/30/2014] [Accepted: 07/21/2014] [Indexed: 10/25/2022]
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9
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Sadjadi SA, Sharif-Hassanabadi M. Fatal pulmonary embolism after hemodialysis vascular access declotting. AMERICAN JOURNAL OF CASE REPORTS 2014; 15:172-5. [PMID: 24790686 PMCID: PMC4004792 DOI: 10.12659/ajcr.890364] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/14/2014] [Accepted: 01/24/2014] [Indexed: 11/16/2022]
Abstract
Patient: Male, 59 Final Diagnosis: Pulmonary embolism Symptoms: Cardiac arrest • chest pain • dyspnea Medication: — Clinical Procedure: Angioplasty Specialty: Nephrology
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Affiliation(s)
- Seyed-Ali Sadjadi
- Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A
| | - Maryam Sharif-Hassanabadi
- Nephrology Section, Jerry L. Pettis Memorial Veterans Medical Center, Loma Linda University School of Medicine, Loma Linda, CA, U.S.A
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Fabbian F, Gallerani M, Pala M, De Giorgi A, Salmi R, Manfredini F, Portaluppi F, Dentali F, Ageno W, Mikhailidis DP, Manfredini R. In-hospital mortality for pulmonary embolism: relationship with chronic kidney disease and end-stage renal disease. The hospital admission and discharge database of the Emilia Romagna region of Italy. Intern Emerg Med 2013; 8:735-40. [PMID: 23247683 DOI: 10.1007/s11739-012-0892-8] [Citation(s) in RCA: 25] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/10/2012] [Accepted: 12/03/2012] [Indexed: 11/30/2022]
Abstract
The impact of chronic kidney disease (CKD) on the outcome of acute pulmonary embolism (PE) is uncertain. We aimed to evaluate the effect of renal dysfunction (defined by ICD-9-CM codification) on in-hospital mortality for PE. We considered all cases of PE (first event) recorded in the database of hospital admissions for the Emilia-Romagna region, Italy, from 1999 to 2009. The inclusion criterion was the presence, as a main discharge diagnosis, of acute PE codes according to ICD-9-CM. Diagnoses of immobilization, dementia, sepsis, skeletal fractures, hypertension, heart failure, myocardial infarction, diabetes mellitus, peripheral vascular disease, cerebrovascular disease, chronic pulmonary disease, pneumonia, malignancy, CKD and end-stage renal disease (ESRD) were also considered to evaluate comorbidity. The outcome was in-hospital mortality for PE, and multivariate logistic regression analyses was performed. We considered 24,690 cases of first episode of PE. In-hospital mortality for PE was not different in patients without renal dysfunction, with CKD, or ESRD (23.6 vs. 24 vs. 18 % p = ns). In-hospital mortality for PE was independently associated with age (OR 1.045, 95 % CI 1.042-1.048, p < 0.001), female sex (OR 1.322, 95 % CI 1.242-1.406, p < 0.001), hypertension (OR 1.096, 95 % CI 1.019-1.178, p = 0.013), diabetes mellitus (OR 1.120, 95 % CI 1.001-1.253, p = 0.049), dementia (OR 1.171, 95 % CI 1.020-1.346, p = 0.025), peripheral vascular disease (OR 1.349, 95 % CI 1.057-1.720, p = 0.016) and malignancy (OR 1.065, 95 % CI 1.016-1.116, p = 0.008). Age and comorbidity are associated with in-hospital mortality for PE, whereas CKD does not appear to be an independent predictor of adverse outcomes in patients hospitalized for PE.
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Affiliation(s)
- Fabio Fabbian
- Clinica Medica, Azienda Ospedaliera-Universitaria, University of Ferrara, via Aldo Moro 8, 44124, Cona, Ferrara, Italy,
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11
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Ocak G, van Stralen KJ, Rosendaal FR, Verduijn M, Ravani P, Palsson R, Leivestad T, Hoitsma AJ, Ferrer-Alamar M, Finne P, De Meester J, Wanner C, Dekker FW, Jager KJ. Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients. J Thromb Haemost 2012; 10:2484-93. [PMID: 22970891 DOI: 10.1111/j.1538-7836.2012.04921.x] [Citation(s) in RCA: 41] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/31/2023]
Abstract
BACKGROUND It is has been suggested that dialysis patients have lower mortality rates for pulmonary embolism than the general population, because of platelet dysfunction and bleeding tendency. However, there is limited information whether dialysis is indeed associated with a decreased mortality risk from pulmonary embolism. OBJECTIVE The aim of our study was to evaluate whether mortality rate ratios for pulmonary embolism were lower than for myocardial infarction and stroke in dialysis patients compared with the general population. METHODS Cardiovascular causes of death for 130,439 incident dialysis patients registered in the ERA-EDTA Registry were compared with the cardiovascular causes of death for the European general population. RESULTS The age- and sex-standardized mortality rate (SMR) from pulmonary embolism was 12.2 (95% CI 10.2-14.6) times higher in dialysis patients than in the general population. The SMRs in dialysis patients compared with the general population were 11.0 (95% CI 10.6-11.4) for myocardial infarction, 8.4 (95% CI 8.0-8.8) for stroke, and 8.3 (95% CI 8.0-8.5) for other cardiovascular diseases. In dialysis patients, primary kidney disease due to diabetes was associated with an increased mortality risk due to pulmonary embolism (HR 1.9; 95% CI 1.0-3.8), myocardial infarction (HR 4.1; 95% CI 3.4-4.9), stroke (HR 3.5; 95% CI 2.8-4.4), and other cardiovascular causes of death (HR 3.4; 95% CI 2.9-3.9) compared with patients with polycystic kidney disease. CONCLUSIONS Dialysis patients were found to have an unexpected highly increased mortality rate for pulmonary embolism and increased mortality rates for myocardial infarction and stroke.
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Affiliation(s)
- G Ocak
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands.
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12
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Kumar G, Sakhuja A, Taneja A, Majumdar T, Patel J, Whittle J, Nanchal R. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol 2012; 7:1584-90. [PMID: 22837271 DOI: 10.2215/cjn.00250112] [Citation(s) in RCA: 61] [Impact Index Per Article: 5.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022]
Abstract
BACKGROUND AND OBJECTIVES CKD and ESRD are growing burdens. It is unclear whether these conditions affect pulmonary embolism (PE) risk, given that they affect both procoagulant and anticoagulant factors. This study examined the frequency and associated outcomes of PE in CKD and ESRD. DESIGN, SETTING, PARTICIPANTS, & MEASUREMENTS The Healthcare Cost and Utilization Project's Nationwide Inpatient Sample was used to estimate the frequency and outcomes of PE in adults with CKD and ESRD. Hospitalizations for the principal diagnosis of PE and presence of CKD or ESRD were identified using International Classification of Diseases, Ninth Revision codes. Data from the annual US Census and US Renal Data System reports were used to calculate the number of adults with CKD, ESRD, and normal kidney function (NKF) as well as the annual incidence of PE in each group. Logistic regression modeling was used to compare in-hospital mortality among persons admitted for PE who had ESRD or CKD to those without these conditions. RESULTS The annual frequency of PE was 527 per 100,000, 204 per 100,000, and 66 per 100,000 persons with ESRD, CKD, and NKF, respectively. In-hospital mortality was higher for persons with ESRD and CKD (P<0.001) compared with persons with NKF. Median length of stay was longer by 1 day in CKD and 2 days in ESRD than among those with NKF. CONCLUSIONS Persons with CKD and ESRD are more likely to have PE than persons with NKF. Once they have PE, they are more likely to die in the hospital.
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Affiliation(s)
- Gagan Kumar
- Division of Pulmonary and Critical Care Medicine, Department of Medicine, Medical College of Wisconsin, Milwaukee, WI 53226, USA
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13
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Ocak G, Vossen CY, Rotmans JI, Lijfering WM, Rosendaal FR, Parlevliet KJ, Krediet RT, Boeschoten EW, Dekker FW, Verduijn M. Venous and arterial thrombosis in dialysis patients. Thromb Haemost 2011; 106:1046-52. [PMID: 22012181 DOI: 10.1160/th11-06-0422] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/22/2011] [Accepted: 08/13/2011] [Indexed: 11/05/2022]
Abstract
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. Furthermore, 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 associations with venous thrombosis did not reach statistical significance due to small numbers. In conclusion, dialysis patients have clearly elevated 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.
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Affiliation(s)
- Gurbey Ocak
- Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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14
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Donati G, Colì L, Cianciolo G, La Manna G, Cuna V, Montanari M, Gozzetti F, Stefoni S. Thrombosis of Tunneled-Cuffed Hemodialysis Catheters: Treatment With High-Dose Urokinase Lock Therapy. Artif Organs 2011; 36:21-8. [DOI: 10.1111/j.1525-1594.2011.01290.x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
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15
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Abstract
PURPOSE OF REVIEW An estimated 13% of Americans have kidney disease. We sought to describe the association of kidney disease with risk of venous thromboembolism and discuss possible mechanisms explaining this association. RECENT FINDINGS All severities of kidney disease appear to increase the risk of venous thromboembolism. In the general population the risk associated with mild to moderate kidney disease is 1.3-2-fold increased, and present even for microalbuminuria, although stage 1 chronic kidney disease itself has not been studied. End-stage renal disease is also associated with a 2.3-fold increased risk, compared to the general population. Although data are limited, risk increases after kidney transplant and with nephrotic syndrome as well. SUMMARY Rates of kidney disease are increasing rapidly in the population and kidney disease is a risk factor for venous thromboembolism. An improved understanding of mechanisms linking kidney disease with venous thromboembolism will allow further study of best prevention efforts.
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Finazzi G, Mingardi G. Oral anticoagulant therapy in hemodialysis patients: do the benefits outweigh the risks? Intern Emerg Med 2009; 4:375-80. [PMID: 19609643 DOI: 10.1007/s11739-009-0281-0] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/05/2009] [Accepted: 06/18/2009] [Indexed: 11/24/2022]
Abstract
Managing oral anticoagulation may be difficult in hemodialysis patients because the antithrombotic effect can be counterbalanced by an increased risk of hemorrhagic complications. There is insufficient evidence to recommend the routine use of warfarin for thrombosis prophylaxis of the vascular access in all patients. If a decision for anticoagulation is made, dosing warfarin to a "therapeutic" level is suggested, although the most appropriate target INR range remains unclear. Many hemodialysis patients with atrial fibrillation have multiple risk factors for stroke and generally benefit from warfarin, with careful and frequent laboratory monitoring. Treatment with standard dose warfarin is also recommended in patients with venous thromboembolism provided that patients do not have contraindications to anticoagulation. For those with such contraindications, placement of an inferior vena cava filter is suggested. These recommendations are limited by the almost complete lack of data in dialysis patients. Sound randomized evidence of efficacy and harm for anticoagulation in these patients will likely never be available. Knowledge of the risk of bleeding and thrombosis in anticoagulated and nonanticoagulated dialysis patients could be provided by feasible, well-designed cohort studies.
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Affiliation(s)
- Guido Finazzi
- Division of Hematology, Ospedali Riuniti di Bergamo, Largo Barozzi 1, 24128 Bergamo, Italy.
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17
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Grebenyuk LA, Marcus RJ, Nahum E, Spero J, Srinivasa NS, McGill RL. Pulmonary embolism following successful thrombectomy of an arteriovenous dialysis fistula. J Vasc Access 2009; 10:59-61. [PMID: 19340802 DOI: 10.1177/112972980901000111] [Citation(s) in RCA: 14] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
A hemodialysis patient was diagnosed with pulmonary embolism, shortly after successful thrombectomy of an autogenous arteriovenous fistula. Diagnostic testing revealed no alternative source for thromboembolism. Increased recognition of hypercoagulability as a common consequence of end-stage renal disease would suggest that dialysis patients would be at risk for thromboembolic events. A fully developed dialysis fistula may have sufficient luminal diameter to harbor subclinical or clinically significant venous thrombi. Clinicians should be alert to the possibility of venous emboli after fistula manipulation.
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Affiliation(s)
- L A Grebenyuk
- Division of Nephrology and Hypertension, West Penn Allegheny Health System, Allegheny General Hospital, Pittsburgh, PA, USA.
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18
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Wattanakit K, Cushman M, Stehman-Breen C, Heckbert SR, Folsom AR. Chronic kidney disease increases risk for venous thromboembolism. J Am Soc Nephrol 2007; 19:135-40. [PMID: 18032796 DOI: 10.1681/asn.2007030308] [Citation(s) in RCA: 245] [Impact Index Per Article: 14.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Chronic kidney disease (CKD) is associated with increased risk for cardiovascular disease morbidity and mortality, but its association with incident venous thromboembolism (VTE) in non-dialysis-dependent patients has not been evaluated in a community-based population. With the use of data from the Longitudinal Investigation of Thromboembolism Etiology (LITE) study, 19,073 middle-aged and elderly adults were categorized on the basis of estimated GFR, and cystatin C (available in 4734 participants) was divided into quintiles. During a mean follow-up time of 11.8 yr, 413 participants developed VTE. Compared with participants with normal kidney function, relative risk for VTE was 1.28 (95% confidence interval [CI] 1.02 to 1.59) for those with mildly decreased kidney function and 2.09 (95% CI 1.47 to 2.96) for those with stage 3/4 CKD, when adjusted for age, gender, race, and center. After additional adjustment for cardiovascular disease risk factors, an increased risk for VTE was still observed in participants with stage 3/4 CKD, with a multivariable adjusted relative risk of 1.71 (95% CI 1.18 to 2.49). There was no significant association between cystatin C and VTE. In conclusion, middle-aged and elderly patients with CKD (stages 3 through 4) are at increased risk for incident VTE, suggesting that VTE prophylaxis may be particularly important in this population.
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Affiliation(s)
- Keattiyoat Wattanakit
- Division of Epidemiology & Community Health, School of Public Health, University of Minnesota, Suite 300, 1300 S. 2nd Street, Minneapolis, MN 55454-1015, USA
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Venkat A, Kaufmann KR, Venkat K. Care of the end-stage renal disease patient on dialysis in the ED. Am J Emerg Med 2006; 24:847-58. [PMID: 17098110 DOI: 10.1016/j.ajem.2006.05.011] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/07/2006] [Revised: 05/23/2006] [Accepted: 05/23/2006] [Indexed: 11/22/2022] Open
Abstract
End-stage renal disease is a major public health problem. In the United States, more than 350,000 patients are being treated with either hemodialysis or continuous ambulatory peritoneal dialysis. Given the high burden of comorbidities in these patients, it is imperative that emergency physicians be aware of the complexities of caring for acute illnesses in this population. This article reviews the common medical problems that bring patients with end-stage renal disease to the emergency department, and their evaluation and management.
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Affiliation(s)
- Arvind Venkat
- Department of Emergency Medicine, University of Cincinnati College of Medicine, Cincinnati, OH 45267-0769, USA.
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20
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Lo DS, Rabbat CG, Clase CM. Thromboembolism and anticoagulant management in hemodialysis patients: A practical guide to clinical management. Thromb Res 2006; 118:385-95. [PMID: 15993930 DOI: 10.1016/j.thromres.2005.03.031] [Citation(s) in RCA: 33] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2005] [Revised: 03/04/2005] [Accepted: 03/08/2005] [Indexed: 11/18/2022]
Abstract
The need for anticoagulation in dialysis patients is common and the incidence of venous thromboembolism (VTE) and atrial fibrillation in this population is high. While direct data are lacking on the management of anticoagulation in dialysis patients, careful weighing of risks and benefits on the basis of evidence from other populations is crucial. VTE should be managed with adjusted dose warfarin for most patients. Placement of an inferior vena cava filter is a reasonable option for those patients with unacceptable bleeding risks. Studies are ongoing to assess the safety of some low-molecular-weight heparins (LMWH), which may potentially be useful for long-term anticoagulation in hemodialysis patients. In atrial fibrillation the available data on risk of bleeding, risk of stroke, and patient preferences should all be taken into account when considering long-term anticoagulation. We have constructed an evidence model to help quantitate the risks and benefits for an individual patient. The impact of dialysis on risk of bleeding is such that the risk of bleeding will outweigh the benefit in many patients, and anticoagulation will not be used: in some of these patients aspirin therapy may be an alternative. Finally, in the area of prevention of graft and access thrombosis, some randomized controlled trials are available, but none have to date shown benefit from anticoagulation for primary or secondary prevention of thrombosis, and the risk of bleeding in these studies was high.
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Affiliation(s)
- Dorothy S Lo
- Department of Medicine, McMaster University, 25 Charlton Avenue, Hamilton, Ontario, Canada
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21
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Pendleton R, Wheeler M, Rodgers G. Venous thromboembolism prevention in the acutely ill medical patient: a review of the literature and focus on special patient populations. Am J Hematol 2005; 79:229-37. [PMID: 15981227 DOI: 10.1002/ajh.20360] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/06/2022]
Abstract
Although venous thromboembolism (VTE) is a major public health problem, until recently, our understanding of the risk of VTE in hospitalized acutely ill medical patients has been incomplete. Fortunately, over the past 5 years, there has been an increasing body of literature that highlights the risk of VTE in the nonsurgical patient, identifies unique patient-risk factors, and defines adequate preventative measures. This review highlights the current literature with regard to epidemiology of VTE in hospitalized medical patients and the risk-stratification of these patients and deals with optimal preventative regimens and prevention strategies in special patient groups.
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Affiliation(s)
- Robert Pendleton
- Department of Internal Medicine, University of Utah, Salt Lake City, Utah 84132, USA.
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22
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Abbott KC, Cruess DF, Agodoa LYC, Sawyers ES, Tveit DP. Early renal insufficiency and late venous thromboembolism after renal transplantation in the united states. Am J Kidney Dis 2004; 43:120-30. [PMID: 14712435 DOI: 10.1053/j.ajkd.2003.08.047] [Citation(s) in RCA: 44] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
Abstract
BACKGROUND Pulmonary embolism (PE) is the most common preventable cause of death in hospitalized patients. Patients with severe chronic kidney disease (CKD) may be at increased risk for PE in comparison to the general population. Whether severe CKD is associated with increased risk for late venous thromboembolism (VTE) in a population of renal transplant recipients has not been determined. METHODS Using the US Renal Data System database, we studied 28,924 patients receiving a kidney transplant from January 1, 1996, to July 31, 2000, with Medicare as primary payer, followed up until December 31, 2000. Cox proportional hazards regression models were used to calculate the association of transplant recipient estimated glomerular filtration rate (eGFR; by the Modification of Diet in Renal Disease formula) less than 30 mL/min/1.73 m2 (versus >30 mL/min/1.73 m2) 1 year after renal transplantation with Medicare claims for VTE (either deep-venous thrombosis or PE/infarction) 1.5 to 3 years after renal transplantation. RESULTS The rate of VTE occurring 1.5 to 3 years after transplantation was 2.9 episodes/1,000 person-years. eGFR less than 30 mL/min/1.73 m2 versus higher at the end of the first year after renal transplantation was associated with significantly increased risk for later VTE (adjusted hazard ratio, 2.05; 95% confidence interval, 1.08 to 3.89). CONCLUSION Patients with severe CKD after renal transplantation should be regarded as high risk for late VTE, which is a potentially preventable cause of death in this population.
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Affiliation(s)
- Kevin C Abbott
- Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, USA.
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23
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Pham Tourreau S, Fattorutto M, Bonnin P, Mazoyer E, Raphaël M, Morin F, Cupa M, Samama CM. Étude des effets directs et indirects de l’érythropoïétine dans un modèle expérimental de thrombose et de saignement chez le lapin. ACTA ACUST UNITED AC 2003; 22:870-8. [PMID: 14644369 DOI: 10.1016/j.annfar.2003.08.007] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
OBJECTIVES To study direct and indirect effects of EPO on haemostasis. STUDY DESIGN Experimental, randomised. ANIMALS Forty-eight New Zealand rabbits. METHOD Animals were anaesthetised, ventilated and monitored continuously for blood pressure, heart rate, body temperature, and carotid blood flow variations and were randomised into four groups: control, EPO bolus 2400 IU kg(-1), fractionated EPO (one injection a week of 600 IU kg(-1) for 4 weeks), homologous red blood cell transfusion to reach the Ht level of the fractionated EPO group. A compression injury and a 75% stenosis of the carotid artery triggered a series of cyclic flow reductions (CFRs). CFRs were observed for a 20 min period in each group. Ear immersion bleeding time (BT) and hepato-splenic bleeding were performed at the end of the experiment. Biology was performed at the end of the thrombosis period: blood cells count, Hte, activated partial thromboplastin time, fibrinogen, arachidonic-induced platelet aggregation, EPO dosages. RESULTS No significant increase in thrombosis (CFRs) in the two EPO groups and in the transfused group. Increase in Hte in the fractionated EPO group versus control. Group EPO bolus: decrease in BT and hepato-splenic bleeding versus control; decrease in hepato-splenic bleeding versus fractionated EPO group, increase in platelet aggregation velocity versus control. CONCLUSION EPO did not increase the thrombotic risk in this rabbit model. EPO bolus decreased BT and hepato-splenic bleeding.
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Affiliation(s)
- S Pham Tourreau
- Laboratoire du groupe de recherche en anesthésie réanimation urgences (GRARU) et Inserm U 348, département d'anesthésie-réanimation, CHU d'Avicenne, université Paris-XIII, France
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24
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Abstract
Although renal failure has classically been associated with a bleeding tendency, thrombotic events are common among patients with end-stage renal disease (ESRD). A variety of thrombosis-favoring hematologic alterations have been demonstrated in these patients. In addition, "nontraditional" risk factors for thrombosis, such as hyperhomocysteinemia, endothelial dysfunction, inflammation, and malnutrition, are present in a significant proportion of chronic dialysis patients. Hemodialysis (HD) vascular access thrombosis, ischemic heart disease, and renal allograft thrombosis are well-recognized complications in these patients. Deep venous thrombosis and pulmonary embolism are viewed as rare in chronic dialysis patients, but recent studies suggest that this perception should be reconsidered. Several ESRD treatment factors such as recombinant erythropoietin (EPO) administration, dialyzer bioincompatibility, and calcineurin inhibitor administration may have prothrombotic effects. In this article we review the pathogenesis and clinical manifestations of thrombosis in ESRD and evaluate the evidence that chronic renal failure or its management predisposes to thrombotic events.
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Affiliation(s)
- Liam F Casserly
- Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA
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25
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Abbott KC. In reply to Ali. Am J Kidney Dis 2002. [DOI: 10.1053/ajkd.2002.37030] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/11/2022]
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26
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IV. NKF-K/DOQI Clinical Practice Guidelines for Anemia of Chronic Kidney Disease: update 2000. Am J Kidney Dis 2001; 37:S182-238. [PMID: 11229970 DOI: 10.1016/s0272-6386(01)70008-x] [Citation(s) in RCA: 383] [Impact Index Per Article: 16.7] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/08/2023]
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27
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Eschbach JW. Treatment of anemia of chronic kidney disease. Am J Kidney Dis 2001. [DOI: 10.1016/s0272-6386(01)80078-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/21/2022]
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28
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Abstract
Venous thromboembolic disease is considered an uncommon event in the end-stage renal disease (ESRD) population. We report five cases of venous thromboembolism (VTE) occurring in dialysis patients within a 1-year period at a single center. Analysis of these cases and review of the literature suggest that risk factors for VTE in the ESRD population are similar to those of the general population. Chronically ill, debilitated patients appear to be those most likely to develop VTE.
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Affiliation(s)
- L F Casserly
- Renal Unit, Evans Memorial Department of Medicine, Boston University School of Medicine, Boston, MA 02118, USA
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