Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients
Article first published online: 12 DEC 2012
© 2012 International Society on Thrombosis and Haemostasis
Journal of Thrombosis and Haemostasis
Volume 10, Issue 12, pages 2484–2493, December 2012
How to Cite
OCAK, G., VAN STRALEN, K. J., ROSENDAAL, F. R., VERDUIJN, M., RAVANI, P., PALSSON, R., LEIVESTAD, T., HOITSMA, A. J., FERRER-ALAMAR, M., FINNE, P., DE MEESTER, J., WANNER, C., DEKKER, F. W. and JAGER, K. J. (2012), Mortality due to pulmonary embolism, myocardial infarction, and stroke among incident dialysis patients. Journal of Thrombosis and Haemostasis, 10: 2484–2493. doi: 10.1111/j.1538-7836.2012.04921.x
- Issue published online: 12 DEC 2012
- Article first published online: 12 DEC 2012
- Accepted manuscript online: 12 SEP 2012 10:05AM EST
- Received 19 July 2012, accepted 31 August 2012
- cardiovascular mortality;
- myocardial infarction;
- pulmonary embolism;
See also Zoccali C, Mallamaci F. Pulmonary embolism in chronic kidney disease: a lethal, overlooked and research orphan disease. This issue, pp 2481–3.
Summary. Background: It is has been suggested that dialysis patients have lower mortality rates for pulmonary embolism than the general population, because of platelet dysfunction and bleeding tendency. However, there is limited information whether dialysis is indeed associated with a decreased mortality risk from pulmonary embolism. Objective: The aim of our study was to evaluate whether mortality rate ratios for pulmonary embolism were lower than for myocardial infarction and stroke in dialysis patients compared with the general population. Methods: Cardiovascular causes of death for 130 439 incident dialysis patients registered in the ERA-EDTA Registry were compared with the cardiovascular causes of death for the European general population. Results: The age- and sex-standardized mortality rate (SMR) from pulmonary embolism was 12.2 (95% CI 10.2–14.6) times higher in dialysis patients than in the general population. The SMRs in dialysis patients compared with the general population were 11.0 (95% CI 10.6–11.4) for myocardial infarction, 8.4 (95% CI 8.0–8.8) for stroke, and 8.3 (95% CI 8.0–8.5) for other cardiovascular diseases. In dialysis patients, primary kidney disease due to diabetes was associated with an increased mortality risk due to pulmonary embolism (HR 1.9; 95% CI 1.0–3.8), myocardial infarction (HR 4.1; 95% CI 3.4–4.9), stroke (HR 3.5; 95% CI 2.8–4.4), and other cardiovascular causes of death (HR 3.4; 95% CI 2.9–3.9) compared with patients with polycystic kidney disease. Conclusions: Dialysis patients were found to have an unexpected highly increased mortality rate for pulmonary embolism and increased mortality rates for myocardial infarction and stroke.