Risk factors for pulmonary embolism in chronic dialysis patients

Risk factors for pulmonary embolism (PE) in end stage renal disease (ESRD) patients have not been studied in a large population.

375,152 patients in the United States Renal Data System initiated on dialysis between 1 January 1992 and 30 June 1997 were analyzed in an historical cohort study of hospitalized PE (ICD9 Code 415.1x) occurring prior to receipt of renal transplant. Cox regression models were used to analyze risk factors for PE in dialysis. Dialysis modality was analyzed in an intention to treat fashion, thus patients who changed modalities later were considered to have remained on the same modality.

The incidence of pulmonary embolism did not increase over time. Independent risk factors for hospitalizations for PE were similar to those in the general population (older age, females, systemic lupus erythematosus, lower risk for Asians) with the addition of peritoneal dialysis (vs. hemodialysis, adjusted odds ratio 1.56, 95% CI 1.15-2.13), polycystic kidney disease, and congestive heart failure. Notably, in Cox regression analysis, no relation was seen with baseline laboratory results (hematocrit, serum albumin, serum creatinine) or comorbidity (except congestive heart failure) and PE risk. Dialysis patients with PE had increased mortality (hazard ratio 1.20, 95% confidence interval 1.08-1.33).

The incidence of PE did not increase significantly in ESRD patients from 1992-1997. PE were associated with increased mortality. Peritoneal dialysis patients may have higher risk of PE than hemodialysis patients, and other high-risk groups were identified.