Chronic dialysis patients have high risk for pulmonary embolism

Tveit, Daniel P.; Hypolite, Iman O.; Hshieh, Paul; Cruess, David F.; Agodoa, Lawrence Y.; Welch, Paul G.; Abbott, Kevin C.

doi:10.1053/ajkd.2002.32774

Cited by 116 publications

(94 citation statements)

References 31 publications

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“…Thrombophilic factors are also common in stage 5 CKD and correctable after kidney transplantation (40). Our finding that the incidence of PE in persons with ESRD is 7.6 times higher than in persons with normal kidney function is similar to that of Tveit et al; however, their estimate of the incidence ratio was slightly lower at 6.09 (15). This may reflect differences in methodology.…”

Section: Discussionsupporting

confidence: 84%

“…Most studies have shown that persons with CKD have an increased risk of venous thromboembolism (VTE) (11)(12)(13)(14), but estimates of the magnitude of the effect vary widely. Moreover, prior investigations of the risk of VTE and/or PE among persons with ESRD show conflicting results (15)(16)(17)(18). Thus, more research is needed to understand the risk of VTE, and especially PE, among persons with renal disease.…”

Section: Introductionmentioning

confidence: 99%

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Pulmonary Embolism in Patients with CKD and ESRD

Kumar

Sakhuja

Taneja

et al. 2012

Clinical Journal of the American Society of Nephrology

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SummaryBackground 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. ResultsThe 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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Section: Discussionsupporting

confidence: 84%

Section: Introductionmentioning

confidence: 99%

Pulmonary Embolism in Patients with CKD and ESRD

Kumar

Sakhuja

Taneja

et al. 2012

Clinical Journal of the American Society of Nephrology

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“…For comparison of rates of nephrolithiasis with the general population in 1997, we used the National Hospital Discharge Survey for 1997, using methods previously described (15). Additional comparison between hospitalized nephrolithiasis after transplant compared with prior to transplant or in patients never transplanted was performed using patients who were placed on the renal transplant waiting list from 1 April 1995 to 29 June 1999, also using methods and a population previously described (16).…”

Section: Discussionmentioning

confidence: 99%

Hospitalized Nephrolithiasis after Renal Transplantation in the United States

Abbott

Schenkman²,

Swanson

et al. 2003

American Journal of Transplantation

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The national incidence of and risk factors for hospitalized nephrolithiasis (NEP) in renal transplant (RT) recipients has not been reported. We conducted a historical cohort study of 42 096 RT recipients in the United States Renal Data System between 1 July 1994 and 30 June 1998. The 1-year incidence of NEP (ICD-9 codes 592.x) after RT in 1997 was compared to the rate of NEP in the general population using the National Hospital Discharge Survey. Associations with time to hospitalizations for a primary diagnosis of nephrolithiasis were assessed by Cox Regression. NEP was uncommon after RT (104 cases per 100 000 person years in 1997). However, females, but not males, had a statistically significant increased risk of NEP compared to the general population (rate ratio for females, 2.84, 95% confidence interval, 2.35-3.58). Kidney stones were more common than ureteral stones, and percutaneous procedures were more common than ureteroscopy or extracorporeal shock wave lithotripsy (ESWL). The only risk factor identified for NEP was renal failure due to stone disease (only one case). NEP was uncommon after RT, but was still more common than in the general population. We identified differences in the presentation and management of NEP after RT in comparison to the general population.

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“…These mechanisms can contribute to a higher incidence of thromboembolic events in hemodialysis patients. According to Tveit et al, the ageadjusted incidence of PE in chronic hemodialysis patients was 2.34-fold higher than that in the general population in the United States [1]. Kumar et al reported that the annual frequency of PE among ESRD patients was eight times higher than among individuals with normal kidney function [2].…”

Section: Discussionmentioning

confidence: 99%

“…However, several clinical studies have found that hemodialysis patients have a higher risk of pulmonary embolism (PE) than the general population, even after adjusting for conventional risk factors [1,2]. The symptoms of PE are non-specific, but its mortality is high.…”

Section: Introductionmentioning

confidence: 99%

Subacute pulmonary embolism in a hemodialysis patient, successfully treated with surgical thrombectomy

et al. 2016

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A 53-year-old woman was admitted to our hospital with a 1-month history of gradually progressive resting dyspnea and lumbar backache. For the preceding 6 years, she had received regular hemodialysis for endstage renal disease caused by autosomal dominant polycystic kidney disease and had taken tamoxifen for 3 years as post-operative chemotherapy for breast cancer. Before admission, the patient's symptoms had been attributed to volume overload, based on right thoracic fluid and leg edema. However, despite volume correction by dialysis therapy, her symptoms had not improved. The patient was transferred to our hospital, where she was diagnosed with subacute pulmonary embolism (PE). Emergent pulmonary thrombectomy was performed using cardio-pulmonary bypass. The patient was discharged from our hospital on post-operative day 23. Recent reports have shown that hemodialysis patients have a relatively higher risk of PE compared with the general population. Our case had additional risk factors for PE: female sex, decreased protein C level, tamoxifen use, and autosomal dominant polycystic kidney disease. These factors may have had a synergistic effect on the onset of PE.

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Chronic dialysis patients have high risk for pulmonary embolism

Cited by 116 publications

References 31 publications

Pulmonary Embolism in Patients with CKD and ESRD

Pulmonary Embolism in Patients with CKD and ESRD

Hospitalized Nephrolithiasis after Renal Transplantation in the United States

Subacute pulmonary embolism in a hemodialysis patient, successfully treated with surgical thrombectomy

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