Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients

Abstract

Summary. 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.

Candidate Gene Analysis of Arteriovenous Fistula Failure in Hemodialysis Patients

“…The prevalence of diabetes among dialysis patients differs considerably worldwide. According to the ERA-EDTA Registry, the prevalence of diabetes mellitus among dialysis patients in Europe is 22% (45), in line with the relatively low prevalence in our study population. Although the interaction analysis does show some influence of diabetes on the genetic associations, elaborate subgroup analyses are not appropriate considering the low proportion of diabetic patients in our population.…”

Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients: a rebuttal

“…In agreement with Okac et al [1], we found that age, female sex and diabetes mellitus (and also hypertension, dementia, peripheral vascular disease and malignancy) were independently associated with mortality. Of course, a pivotal important difference is that the study by Ocak et al [1] studied age-and sex-mortality in patients derived from the European Renal Association -European Dialysis and Transplant Association Registry, whereas we focused on in-hospital PE-related death [3,4]. This may represent a major issue, given that the diagnosis of PE during hemodialysis is difficult, and PE ranks in second position, after coronary heart disease (7.5% of cases), among necropsy-confirmed causes of out-of-hospital sudden deaths in the general population [5].…”

“…First, the choice of identification codes: death attributable to PE was defined by ERA-EDTA code 21 in the study by Okac et al [1], and we utilized the ICD-9-CM code 415.1 to identify all subjects with emergency hospital admissions for PE. Second, in the study by Okac et al [1] older age at the beginning of renal replacement therapy (equal to or > 85 years) was associated with an increased risk of PE. However, the authors did not include co-morbidities in the analysis, and it is likely that these were more prevalent in dialysis patients.…”

Healthcare burden of venous thromboembolism in childhood chronic renal diseases

“…One previous report suggested that only about 23% of VTE-associated deaths are directly attributable to VTE, with the remaining portion being attributable to underlying diseases [2]. Nonetheless, VTE (specifically PE) has recently been reported to significantly impact mortality in adults on dialysis [33]. It is not possible to assess reasons why subjects may have dropped out of this dataset (e.g.…”