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Thrombosis in end-stage renal disease
Liam F Casserly1, Laura M Dember
1Renal Section, Department of Medicine, Boston University School of Medicine, Boston, Massachusetts 02118, USA.
Seminars in Dialysis
|May 20, 2003
Summary
Patients with end-stage renal disease (ESRD) face a high risk of thrombotic events due to hematologic changes and nontraditional risk factors. Management strategies may also contribute to this increased thrombosis risk.
Area of Science:
- Nephrology
- Hematology
- Vascular Biology
Background:
- End-stage renal disease (ESRD) is classically linked to bleeding, but thrombotic events are prevalent.
- Patients with ESRD exhibit hematologic alterations and nontraditional risk factors like hyperhomocysteinemia, endothelial dysfunction, inflammation, and malnutrition, promoting thrombosis.
- Complications include hemodialysis vascular access thrombosis, ischemic heart disease, and renal allograft thrombosis.
Purpose of the Study:
- To review the pathogenesis and clinical manifestations of thrombosis in ESRD.
- To evaluate evidence linking chronic renal failure and its management to thrombotic events.
Main Methods:
- Literature review of studies on thrombosis in ESRD patients.
- Analysis of hematologic alterations and nontraditional risk factors.
- Examination of prothrombotic effects of ESRD treatments.
Main Results:
- ESRD patients have multiple thrombosis-favoring hematologic changes and nontraditional risk factors.
- Hemodialysis access thrombosis, ischemic heart disease, and allograft thrombosis are common.
- Recombinant erythropoietin (EPO), dialyzer bioincompatibility, and calcineurin inhibitors may promote thrombosis.
Conclusions:
- Chronic renal failure and its management significantly predispose patients to thrombotic events.
- The perception of deep venous thrombosis and pulmonary embolism as rare in ESRD requires reevaluation.
- Understanding these prothrombotic mechanisms is crucial for patient management.