PURPOSE: Venous thromboembolism (VTE) is a major health problem with substantial morbidity and mortality. Renal risk factors like nephrotic syndrome and glomerulonephritis are well documented but the association with chronic kidney disease (CKD) and end stage renal disease (ESRD) is limited. Both CKD and ESRD are pro inflammatory states and there is a well established nexus between inflammation and coagulation. However patients on ESRD also frequently receive anticoagulation mostly in the form of heparin during dialysis session. We hypothesized that the frequency of VTE would be higher is patients with CKD but lower in the population with ESRD. We also examined the effects of CKD and ESRD on the outcomes of VTE.
METHODS: Using the Nationwide Inpatient Sample 2007, patients older than18 years of age, discharged with primary diagnosis of VTE and any diagnosis of CKD stage 1-5 or ESRD were identified through appropriate ICD-9, clinical modification codes. Outcome variables included frequency and in-hospital mortality of VTE in CKD. The similar outcomes of VTE in ESRD patients was examined separately. Multivariate regression analysis was used to adjust for age, sex, clinically relevant co-morbid conditions and PESI score.
RESULTS: There were estimated 1,800,261 discharges with CKD and 936,252 with ESRD in 2007. The frequency of VTE in non-CKD, CKD and dialysis population was 0.58%, 0.69% and 0.43% respectively. After adjusting, the frequency of VTE was significantly reduced (OR 0.65; 95%CI 0.61-0.69) in dialysis patients while it was not significantly different in CKD patients.In-hospital mortality in patients admitted with primary diagnosis of VTE was 2.0% in non-CKD patients and 4.68 % for CKD (adjusted OR 1.38, 95%CI 1.11-1.70) and 5.7% for ESRD(adjusted OR 1.48; 95%CI 1.03-2.13).
CONCLUSION: Using nationally representative data, this observational study showed that frequency of VTE is significantly lower in patients with ESRD but not in patients admitted with CKD. VTE was associated with a higher mortality in patients with CKD and ESRD.
CLINICAL IMPLICATIONS: The frequency of VTE is significantly lower in ESRD patients but not in CKD patients.
DISCLOSURE: Gagan Kumar, No Financial Disclosure Information; No Product/Research Disclosure Information