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Mortality due to bleeding, myocardial infarction and stroke in dialysis patients.
J Thromb Haemost. 2018 Jul 31;:
Authors: Ocak G, Noordzij M, Rookmaaker MB, Cases A, Couchoud C, Heaf JG, Jarraya F, De Meester J, Groothoff JW, Waldum-Grevbo BE, Palsson R, Resic H, Remón C, Finne P, Stendahl M, Verhaar MC, Massy ZA, Dekker FW, Jager KJ
Abstract
BACKGROUND: Dialysis has been associated with both bleeding and thrombotic events. However, there is limited information on bleeding as cause of mortality versus arterial thrombosis as cause of death.
OBJECTIVES: The aim of this study was to investigate the occurrence of bleeding, myocardial infarction and stroke as a cause of death in the dialysis population as compared with the general population.
METHODS: We included 201,918 patients from 11 countries providing data to the ERA-EDTA Registry who started dialysis treatment between 1994-2011 and followed them for three years. Age-and sex-standardized mortality rate ratios for bleeding, myocardial infarction and stroke as cause of death were calculated in dialysis patients as compared with the European general population. Associations between potential risk factors and these causes of death in dialysis patients were investigated by calculating hazard ratios (HRs) with 95% confidence intervals (CIs) using Cox proportional-hazards regression.
RESULTS: Compared with the general population, the age- and sex-standardized mortality rate ratios in dialysis patients were 12.8 (95% CI 11.9-13.7) for bleeding as a cause of death (6.2 per 1000 person-years among dialysis patients versus 0.3 per 1000 person-years in the general population), while it was 13.4 (95% CI 13.0-13.9) for myocardial infarction (22.5 versus 0.9 per 1000 person-years) and 12.4 (95% CI 11.9-12.9) for stroke (14.3 versus 0.7 per 1000 person-years).
CONCLUSION: Dialysis patients have highly increased risks of death due to bleeding and arterial thrombosis as compared with the general population. Clinicians should be aware of the increased mortality risks caused by these conditions. This article is protected by copyright. All rights reserved.
PMID: 30063819 [PubMed - as supplied by publisher]