Deep vein thrombosis in patients with chronic kidney disease

H. Leon Daneschvar; Ali Seddighzadeh; Gregory Piazza; Samuel Z. Goldhaber

doi:10.1160/TH08-02-0107

Thrombosis and Haemostasis, Inhaltsverzeichnis

Thromb Haemost 2008; 99(06): 1035-1039
DOI: 10.1160/TH08-02-0107

Blood Coagulation, Fibrinolysis and Cellular Haemostasis

Schattauer GmbH

Deep vein thrombosis in patients with chronic kidney disease

H. Leon Daneschvar

¹Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, Massachussetts, USA

,

Ali Seddighzadeh

¹Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, Massachussetts, USA

,

Gregory Piazza

²Cardiovascular Division, Department of Medicine, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, Massachussetts, USA

,

Samuel Z. Goldhaber

¹Cardiovascular Medicine Division, Department of Medicine, Brigham and Women’s Hospital; Harvard Medical School, Boston, Massachussetts, USA

› Institutsangaben

Abstract

Summary

Deep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome.We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p<0.0001), more often African- American (p<0.0001), and more often Hispanic (p=0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p=0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p=0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p<0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p=0.003) and difficulty ambulating (5.4% vs. 10.1%, p=0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p=0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.

Keywords

Chronic kidney disease - deep venous thrombosis - pulmonary embolism - prevention - renal failure - venous thromboembolism

Volltext

Referenzen

References
1 Coresh J, Astor BC, Greene T. et al. Prevalence of chronic kidney disease and decreased kidney function in the adult US population: Third National Health and Nutrition Examination Survey. Am J Kidney Dis 2003; 41: 1-12.
2 Levey AS, Eckardt KU, Tsukamoto Y. et al. Definition and classification of chronic kidney disease: a position statement from Kidney Disease: Improving Global Outcomes (KDIGO). Kidney Int 2005; 67: 2089-2100.
3 Boccardo P, Remuzzi G, Galbusera M. Platelet dysfunction in renal failure. Semin Thromb Hemost 2004; 30: 579-589.
4 Monreal M, Falga C, Valle R. et al. Venous thromboembolism in patients with renal insufficiency: findings from the RIETE Registry. Am J Med 2006; 119: 1073-1079.
5 Falga C, Capdevila JA, Soler S. et al. Clinical outcome of patients with venous thromboembolism and renal insufficiency. Findings from the RIETE registry. Thromb Haemost 2007; 98: 771-776.
6 Wattanakit K, Cushman M, Stehman-Breen C. et al. Chronic kidney disease increases risk for venous thromboembolism. J Am Soc Nephrol 2008; 19: 135-140.
7 Mahmoodi BK, Ten Kate MK, Waanders F. et al. High absolute risks and predictors of venous and arterial thromboembolic events in patients with nephrotic syndrome. Results from a large retrospective cohort study. Circulation 2008; 117: 224-230.
8 Goldhaber SZ, Tapson VF. A prospective registry of 5,451 patients with ultrasound-confirmed deep vein thrombosis. Am J Cardiol 2004; 93: 259-262.
9 Gocke J. Lower Extremity Venous Ultrasonography. In: Essentials of Vascular Laboratory Diagnosis Blackwell Publishing. 2005; 184-206.
10 Feldman HI, Klag MJ, Chiapella AP. et al. Endstage renal disease in US minority groups. Am J Kidney Dis 1992; 19: 397-410.
11 Jamerson KA. Preventing chronic kidney disease in special populations. Am J Hypertens 2005; 18: 106S-111S.
12 Tareen N, Zadshir A, Martins D. et al. Chronic kidney disease in African American and Mexican American populations. Kidney Int Suppl 2005; S137-140.
13 Joffe HV, Kucher N, Tapson VF. et al. Upper-extremity deep vein thrombosis: a prospective registry of 592 patients. Circulation 2004; 110: 1605-1611.
14 Bernardi E, Pesavento R, Prandoni P. Upper extremity deep venous thrombosis. Semin Thromb Hemost 2006; 32: 729-736.
15 Dentali F, Riva N, Gianna M. et al. Prevalence of renal failure and use of antithrombotic prophylaxis among medical inpatients at increased risk of venous thromboembolic events. Thromb Res. 2008 in press.
16 Cook D, Douketis J, Meade M. et al. Venous thromboembolism and bleeding in critically ill patients with severe renal insufficiency receiving dalteparin thromboprophylaxis: prevalence, incidence and risk factors. Critical Care. 2008 in press.
17 Kayali F, Najjar R, Aswad F. et al. Venous thromboembolism in patients hospitalized with nephrotic syndrome. Am J Med 2008; 121: 226-230.
18 Baarslag HJ, van Beek EJ, Koopman MM. et al. Prospective study of color duplex ultrasonography compared with contrast venography in patients suspected of having deep venous thrombosis of the upper extremities. Ann Intern Med 2002; 136: 865-872.
19 Alpert JS. Are data from clinical registries of any value?. Eur Heart J 2000; 21: 1399-1401.