Thrombosis incidence in dialysis patients: A systematic review and meta-analysis

To determine the incidence of thrombosis in dialysis patients and to investigate potential associated factors.

Thrombosis is a common complication and a major contributor to vascular access dysfunction in dialysis patients. However, reported thrombosis incidences vary considerably across studies, and a comprehensive overview is lacking.

This systematic review and meta-analysis was conducted following PRISMA guidelines. A comprehensive search was performed in Web of Science, PubMed, Scopus, ProQuest, Ovid, Science Direct, Clinical Key, EMBASE, CINAHL, SID, and MagIran databases up to December 2023. Keywords used included "Thrombosis," "end-stage renal disease," "end-stage kidney disease," "hemodialysis," "dialysis," and their Persian equivalents. After duplicate removal and title/abstract screening, eligible articles underwent full-text review for inclusion. Data on thrombosis incidence, type, location, and study population characteristics were extracted. Heterogeneity was assessed using Cochran's Q test and I² statistics. Methodological quality was evaluated using the STROBE checklist. Meta-analysis was performed using CMA version 2 and STATA version 14 software.

Out of 12,604 identified articles, 58 studies (including 87,150 patients) met the inclusion criteria. The pooled incidence of thrombosis in dialysis patients was 14.7 % (95 % CI: 11.9-17.6). Late thrombosis incidence (7.2 %, 95 % CI: 0.4-20.3) was significantly higher than early thrombosis (2.8 %, 95 % CI: 0.6-7.9). Additionally, thrombosis incidence was significantly higher in patients older than 50 years (15.7 %, 95 % CI: 12.4-19.3) and those using arteriovenous grafts (28.7 %, 95 % CI: 22.9-34.8).

This meta-analysis demonstrates a high incidence of thrombosis among dialysis patients, particularly in older adults and those with arteriovenous grafts. Given the potential for serious complications, implementing preventative measures such as functional exercises, self-care education, and anticoagulation therapy in these high-risk patient populations is crucial.