D-Dimers in Hemodialysis Patients

Miozzari, Marco; Wahl, Christoph

doi:10.1159/000046004

Cited by 8 publications

(10 citation statements)

References 7 publications

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“…The investigators then compared their subjects on the basis of renal function and observed that renal insufficiency was independently associated with elevations in the levels of inflammatory and procoagulant biomarkers, including D-dimers. Their results are in accord with the findings of earlier reports that suggested that D-dimers may indicate the presence of cardiovascular disease (33,34). D-dimers are fibrin degradation products and reflect an activated coagulation pathway (33,34).…”

Section: Discussionsupporting

confidence: 92%

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Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis

Hocher¹,

Ziebig²,

Altermann³

et al. 2003

Journal of the American Society of Nephrology

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Abstract. Diabetic patients undergoing hemodialysis demonstrate much worse survival rates than do nondiabetic patients undergoing hemodialysis. To search for risk predictors, a prospective cohort study was performed with 245 hemodialysis patients, including 84 with diabetes mellitus, for 2 yr. C-reactive protein, troponin T (TnT), total, HDL, LDL, and lipoprotein(a) cholesterol, apoA2, apoB, triglyceride, fibrinogen, Ddimer, albumin, and creatinine levels and clinical characteristics at the time of entry were recorded. Survival rates were compared with Kaplan-Meier and Cox regression analyses. Forty-three diabetic patients and 30 nondiabetic patients died. Among diabetic patients, oliguria (Ͻ200 ml/d) (relative risk, 3.24; 95% confidence interval, 1.63 to 6.41; P ϭ 0.001), elevated C-reactive protein levels (relative risk, 2.57; 95% confidence interval, 1.06 to 6.18; P ϭ 0.035), and elevated D-dimer levels (relative risk, 2.36; 95% confidence interval, 1.11 to 5.01; P ϭ 0.025) predicted all-cause mortality rates. Oliguria was by far the most important predictor, particularly for infectious disease-related death (relative risk, 23.35; 95% confidence interval, 2.60 to 209.97; P ϭ 0.005). Among nondiabetic patients, elevated TnT levels (relative risk, 4.00; 95% confidence interval, 1.58 to 10.10; P ϭ 0.003), elevated D-dimer levels (relative risk, 3.45; 95% confidence interval, 1.27 to 9.33; P ϭ 0.015), and low cholesterol levels (relative risk, 3.61; 95% confidence interval, 1.34 to 9.71; P ϭ 0.011) predicted all-cause mortality rates. Subdivision of the causes of death among nondiabetic patients revealed that TnT levels predicted cardiovascular mortality rates (relative risk, 5.38; 95% confidence interval, 1.11 to 26.10; P ϭ 0.037) and infectious disease-related mortality rates (relative risk, 12.02; 95% confidence interval, 1.42 to 191.96; P ϭ 0.023). In conclusion, mortality predictors among patients undergoing hemodialysis differed substantially between diabetic and nondiabetic patients. Strategies to reduce mortality rates should consider these differences.Hemodialysis techniques have improved remarkably in recent decades, and prospective randomized trials have been conducted to improve outcomes among patients undergoing dialysis. A well accepted, albeit complex, set of guidelines has been established in the United States and Europe to ensure the quality of dialysis care. However, outcomes remain poor (1-3). Cardiovascular disease is the most common cause of death, and infectious causes are second in frequency (4,5). Dialysis-related strategies have not been successful in reducing mortality rates. The underlying renal disease, preexisting coronary artery disease, malnutrition, systemic inflammation [as indicated by C-reactive protein (CrP) levels], elevated levels of cardiac enzymes [notably troponin T (TnT)], and poor residual renal function (oliguria) have all been identified as risk factors (6 -12). Diabetes mellitus is the most important clinical risk factor; diabetic patients have a life expectancy with ...

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Section: Discussionsupporting

confidence: 92%

“…Their results are in accord with the findings of earlier reports that suggested that D-dimers may indicate the presence of cardiovascular disease (33,34). D-dimers are fibrin degradation products and reflect an activated coagulation pathway (33,34).…”

Section: Discussionsupporting

confidence: 92%

Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis

Hocher¹,

Ziebig²,

Altermann³

et al. 2003

Journal of the American Society of Nephrology

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“…49 Plasma D-dimers are increased in MHD, although their diagnostic value has been questioned. 50 In MHD patients, D-dimers have been correlated with bleeding propensity rather than hypercoagulability 51 ; however, D-dimers predict mortality in ESRD patients. 52 The finding that either ramipril or valsartan reduced D-dimers levels in the MHD patients confirms data from clinical trials in patients without ESRD, such as the Perindopril-Thrombosis Inflammation, Endothelial Dysfunction and Neurohormonal Activation Trial (PERTINENT) and the Trial of Angiotensin-Converting Enzyme Inhibition and Novel Cardiovascular Risk Factors.…”

Section: Discussionmentioning

confidence: 99%

Comparative Effects of Angiotensin-Converting Enzyme Inhibition and Angiotensin-Receptor Blockade on Inflammation during Hemodialysis

Gamboa¹,

Pretorius²,

Todd-Tzanetos³

et al. 2012

Journal of the American Society of Nephrology

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Biomarkers of oxidative stress and inflammation predict cardiovascular events in maintenance hemodialysis patients. Angiotensin-converting enzyme (ACE) inhibitors and angiotensin-receptor blockers (ARBs) reduce cardiovascular mortality in the general population, but their benefit in maintenance hemodialysis patients is not fully explored. To test whether ACE inhibitors and ARBs differentially affect markers of oxidative stress, inflammation, and fibrinolysis during hemodialysis, we conducted a randomized, doubleblind, placebo-controlled 333 crossover study. We randomly assigned 15 participants undergoing hemodialysis to placebo, ramipril (5 mg/d), and valsartan (160 mg/d) for 7 days, with a washout period of 3 weeks in between the treatments. On the morning of the seventh day of drug treatment, participants underwent serial blood sampling during hemodialysis. Neither ramipril nor valsartan affected BP during hemodialysis. Ramipril increased IL-1b concentrations (P=0.02) and decreased IL-10 concentrations (P=0.04) compared with placebo. Valsartan and ramipril both lowered IL-6 levels during dialysis (P,0.01 for each compared with placebo). Valsartan increased F 2 -isoprostane levels, and ramipril suggested a similar trend (P=0.09). Valsartan and ramipril both lowered D-dimer levels (P,0.01 for both), whereas only ramipril seemed to prevent a rise in vWf levels (P=0.04). In summary, during hemodialysis, valsartan induces a greater anti-inflammatory effect compared with ramipril, although ramipril seems to prevent dialysis-induced endothelial dysfunction as measured by levels of vWf. A prospective clinical trial is necessary to determine whether ACE inhibitors and ARBs also differ with respect to their effects on cardiovascular mortality in this population. 23: 334-342, 201223: 334-342, . doi: 10.1681 In ESRD patients, cardiovascular death accounts for .50% of overall mortality and the risk of cardiovascular death is 30 times higher than in the general population. 1,2 Moreover, patients undergoing maintenance hemodialysis (MHD) have a 5-year survival rate of 10% after acute myocardial infarction. 3 Traditional risk factors, as used in Framingham risk scoring, only explain half of the excessive cardiovascular mortality observed in ESRD patients, 4 and it is thought that other factors contribute to the high cardiovascular mortality among ESRD patients. J Am Soc NephrolIncreased oxidative stress and inflammation may contribute to accelerated atherosclerosis and cardiovascular events in patients with MHD. 5,6 Markers of oxidative stress, such as F 2 -isoprostanes, are increased in MHD patients. 7,8 Inflammatory markers, particularly IL-1, IL 6, and TNFa, are also elevated in MHD patients and are associated with

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“…Several previous studies have shown that patients with chronic kidney disease not on dialysis have higher D‐dimer values than healthy population, but still within normal range, and that D‐dimer levels correlate with the level of renal function . In dialysis patients, a high prevalence of positive values was reported in patients without symptoms of VTE . Furthermore, in a study of patients referred to computed tomography angiography to rule out pulmonary embolism, none of the 29 patients with eGFR <30 mL/min had a negative D‐dimer, although in only 17% of them pulmonary embolism was confirmed …”

Section: Discussionmentioning

confidence: 95%

“…The specificity of D‐dimer for diagnosis of VTE is further reduced in patients with mild or moderate renal insufficiency, whose D‐dimer levels were found to correlate with the level of impairment of renal function . The diagnostic value of D‐dimer is even more uncertain in hemodialysis patients who, in addition to end‐stage renal disease, often have several comorbidities, including atherosclerosis and malignancy, which are associated with increased D‐dimer …”

Section: Introductionmentioning

confidence: 99%

D‐dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases

Gubenšek

Lolic

Ponikvar

et al. 2015

Hemodialysis International

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We aimed to estimate the prevalence of elevated D-dimer levels in all chronic hemodialysis patients and those without additional disease, and to identify factors associated with increased D-dimer. In 167 chronic hemodialysis patients from our center, D-dimer was measured before dialysis. The effects of age, C-reactive protein (CRP), recent acute illness, vascular access, anticoagulation type, dialysis vintage, and chronic diseases, considered to predispose for increased D-dimer levels, were analyzed. The median D-dimer in the whole group was 966 (inter-quartile range [IQR] 524-1947) μg/L and was positive (>500 μg/L) in 75% of cases. D-dimer was positive in 91% of patients with acute illness, 76% of those with predisposing chronic diseases, but was still positive in 52% of patients without additional disease (i.e., acute illness or predisposing chronic diseases) - median D-dimer was 538.5 (IQR 359-966) μg/L. D-dimer was correlated to patients' age, but not dialysis vintage. In univariate analysis, the D-dimer levels were significantly higher in patients with atrial fibrillation, ischemic heart disease, recent acute illness, increased CRP, dialyzed over a catheter, and on citrate anticoagulation. Multivariate logistic regression showed that only age >65 years (odds ratio [OR] 2.93), catheter (OR 4.86), and positive CRP (OR 4.07) were independently associated with positive D-dimer at 500 μg/L cut-off, while the significance of age disappeared at 2000 μg/L cut-off. To conclude, the high prevalence of positive D-dimer values even in hemodialysis patients without additional disease limits the use of D-dimer for exclusion of thromboembolic diseases in hemodialysis patients.

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D-Dimers in Hemodialysis Patients

Cited by 8 publications

References 7 publications

Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis

Different Impact of Biomarkers as Mortality Predictors among Diabetic and Nondiabetic Patients Undergoing Hemodialysis

Comparative Effects of Angiotensin-Converting Enzyme Inhibition and Angiotensin-Receptor Blockade on Inflammation during Hemodialysis

D‐dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases

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