Bleeding risk of haemodialysis and peritoneal dialysis patients

Abstract

Background Dialysis patients have an increased bleeding risk as compared with the general population. However, there is limited information whether bleeding risks are different for patients treated with haemodialysis (HD) or peritoneal dialysis (PD). From a clinical point of view, this information could influence therapy choice. Therefore the aim of this study was to investigate the association between dialysis modality and bleeding risk. Methods Incident dialysis patients from the Netherlands Cooperative Study on the Adequacy of Dialysis were prospectively followed for major bleeding events over 3 years. Hazard ratios with 95% confidence intervals (CIs) were calculated for HD compared with PD using a time-dependent Cox regression analysis, with updates on dialysis modality. Results In total, 1745 patients started dialysis, of whom 1211 (69.4%) received HD and 534 (30.6%) PD. The bleeding rate was 60.8/1000 person-years for HD patients and 34.6/1000 person-years for PD patients. The time-dependent Cox regression analysis showed that after adjustment for age, sex, primary kidney disease, prior bleeding, cardiovascular disease, antiplatelet drug use, vitamin K antagonist use, erythropoietin use, arterial hypertension, residual glomerular filtratin rate, haemoglobin and albumin levels, bleeding risk for HD patients compared with PD increased 1.5-fold (95% CI 1.0–2.2). Conclusions In this large prospective cohort of incident dialysis patients, HD patients had an increased bleeding risk compared with PD patients. In particular, HD patients with a history of prior bleeding had an increased bleeding risk.

Bleeding Risk Assessment in End-Stage Kidney Disease: Validation of Existing Risk Scores and Evaluation of a Machine Learning-Based Approach

“…Existing bleeding risk assessment tools, such as the HAS-BLED score, are widely used in non-dialysis patients and have been incorporated in several guidelines to assess bleeding risk in patients on antithrombotic therapy, particularly in patients with atrial fibrillation (AF) on oral anticoagulation (9)(10)(11)(12). Optimal bleeding risk assessment in patients on dialysis is desirable for several reasons during patient management: (i) Bleeding risk could be considered to enable informed decision making such as the ideal dialysis treatment modality as several studies highlighted significantly lower bleeding rates in patients on peritoneal dialysis compared to HD (13)(14)(15). (ii) High-risk patients might benefit from close monitoring, control of risk factors, and decision of anticoagulation regimens for HD.…”

“…9 10 11 12 Optimal bleeding risk assessment in patients on dialysis is desirable for several reasons during patient management: (1) bleeding risk could be considered to enable informed decision making such as the ideal dialysis treatment modality as several studies highlighted significantly lower bleeding rates in patients on peritoneal dialysis compared with HD. 13 14 15 (2) High-risk patients might benefit from close monitoring, control of risk factors, and decision of anticoagulation regimens for HD. (3) Further, AF is common in patients on HD and oral anticoagulation for stroke prevention is indicated in the vast majority of ESKD patients with AF.…”

The use of non‐vitamin K oral anticoagulants in dialysis patients—A systematic review

“…30 HD patients also have a higher underlying risk of bleeding due to intermittent puncture of the vascular access with needles. 30 A previous bleeding history is another important risk factor, and dialysis patients belonging to this subgroup are reported to be at the highest risk of a new bleeding event. [30][31][32] Consequently, the added benefit of stroke prevention in dialysis patients with AF could be outbalanced by an increased risk of bleeding.…”

“…30 A previous bleeding history is another important risk factor, and dialysis patients belonging to this subgroup are reported to be at the highest risk of a new bleeding event. [30][31][32] Consequently, the added benefit of stroke prevention in dialysis patients with AF could be outbalanced by an increased risk of bleeding. 9 This, in conjunction with absence of large-scale randomized controlled trials (RCTs) in ESRD, makes use of NOACs in dialysis patients debatable.…”

Coronary Stent Thrombosis and Mortality: Does the Relationship Stand the Test of Time?

“…Therefore, the incidence of bleeding and its associated mortality 5 are increased and hence this may explain the identification of dialysis status in that same study as an independent predictor of mortality, given the baseline high bleeding risk in patients with advanced kidney disease. 6 , 7 Furthermore, these patients are more likely to receive future cardiac testing (including invasive angiography) to investigate symptoms, therefore subjecting them to additional procedures and their associated risks.…”