Mortality due to bleeding, myocardial infarction and stroke in dialysis patients

G Ocak1, M Noordzij2, M B Rookmaaker1

  • 1Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands.

Insights

Dialysis patients face significantly higher mortality risks from both bleeding and arterial thrombosis compared to the general population. These findings highlight the critical need for increased clinical awareness and management of these risks in dialysis care.

Area of Science:

  • Nephrology
  • Cardiovascular Medicine
  • Public Health

Background:

  • Dialysis is linked to increased risks of bleeding and thrombotic events.
  • Limited data exists comparing bleeding as a cause of death versus arterial thrombosis in dialysis patients.

Purpose of the Study:

  • To investigate the comparative mortality rates of bleeding, myocardial infarction, and stroke in dialysis patients versus the general population.
  • To identify potential risk factors associated with these causes of death in dialysis patients.

Main Methods:

  • Analysis of 201,918 patients from 11 countries in the ERA-EDTA Registry, initiating dialysis between 1994-2011, with a 3-year follow-up.
  • Calculation of age- and sex-standardized mortality rate ratios for bleeding, myocardial infarction, and stroke in dialysis patients compared to the European general population.
  • Utilized Cox proportional-hazards regression to determine hazard ratios (HRs) and 95% confidence intervals (CIs) for risk factors.

Main Results:

  • Dialysis patients exhibited significantly elevated mortality rate ratios: 12.8 for bleeding, 13.4 for myocardial infarction, and 12.4 for stroke compared to the general population.
  • Mortality rates per 1000 person-years were substantially higher in dialysis patients for bleeding (6.2 vs. 0.3), myocardial infarction (22.5 vs. 0.9), and stroke (14.3 vs. 0.7).

Conclusions:

  • Dialysis is associated with markedly increased risks of death due to bleeding and arterial thrombosis.
  • Healthcare providers must be vigilant regarding the heightened mortality risks from bleeding and thrombosis in patients undergoing dialysis.

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