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Mortality due to bleeding, myocardial infarction and stroke in dialysis patients
Author(s): ,
G. Ocak
Affiliations:
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
Correspondence: G. Ocak, Department of Nephrology and Hypertension, University Medical Center Utrecht, 3584 CX Utrecht, the Netherlands|Tel.: +31 88 75 573 29|E‐mail: G.Ocak@umcutrecht.nl
,
M. Noordzij
Affiliations:
ERA‐EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
,
M. B. Rookmaaker
Affiliations:
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
,
A. Cases
Affiliations:
Registre de Malalts Renals de Catalunya, Universitat de Barcelona, IDIBAPS, Barcelona, Spain
,
C. Couchoud
Affiliations:
REIN Registry, Agence de Biomedecine, Saint Denis La Plaine, France
,
J. G. Heaf
Affiliations:
Department of Medicine, Zealand University Hospital, Roskilde, Denmark
,
F. Jarraya
Affiliations:
Department of Nephrology, Sfax University Hospital and Research Unit, Faculty of Medicine, Sfax University, Sfax, Tunisia
,
J. De Meester
Affiliations:
Department of Nephrology, Dialysis and Hypertension, Dutch‐Speaking Belgian Renal Registry, Sint‐Niklaas, Belgium
,
J. W. Groothoff
Affiliations:
Department of Pediatric Nephrology, Emma Children's Hospital, Academic Medical Center, Amsterdam
,
B. E. Waldum‐Grevbo
Affiliations:
Department of Nephrology, Oslo University Hospital Ullevål, Oslo, Norway
,
R. Palsson
Affiliations:
Division of Nephrology, Internal Medicine Services, Landspitali – The National University Hospital of Iceland, Reykjavik, Iceland. Faculty of Medicine, School of Health Sciences, University of Iceland, Reykjavik, Iceland
,
H. Resic
Affiliations:
Clinic for Hemodialysis, Clinical Center University of Sarajevo, Sarajevo, Bosnia and Herzegovina
,
C. Remón
Affiliations:
SICATA (The Information System of the Andalusian Transplant Autonomic Coordination Registry), Andalusia, Spain
,
P. Finne
Affiliations:
Finnish Registry for Kidney Diseases, Helsinki, Finland
,
M. Stendahl
Affiliations:
Swedish Renal Registry, Department of Internal Medicine, Ryhov County Hospital, Jönköping, Sweden
,
M. C. Verhaar
Affiliations:
Department of Nephrology and Hypertension, University Medical Center Utrecht, Utrecht, the Netherlands
,
Z. A. Massy
Affiliations:
Division of Nephrology, Ambroise Paré University Hospital, APHP, Boulogne Billancourt/Paris, France. INSERM Unit 1018, CESP, Team 5, UVSQ, Villejuif, France
,
F. W. Dekker
Affiliations:
Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, the Netherlands
K. J. Jager
Affiliations:
ERA‐EDTA Registry, Department of Medical Informatics, Academic Medical Center, University of Amsterdam, Amsterdam Public Health Research Institute, Amsterdam, the Netherlands
ISTH Academy. Ocak G. Oct 4, 2018; 234156

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Background
Dialysis has been associated with both bleeding and thrombotic events. However, there is limited information on bleeding as a cause of death versus arterial thrombosis as a cause of death.
Objectives
To investigate the occurrence of bleeding, myocardial infarction and stroke as causes of death in the dialysis population as compared with the general population.
Methods
We included 201 918 patients from 11 countries providing data to the ERA‐EDTA Registry who started dialysis treatment between 1994 and 2011, and followed them for 3 years. Age‐standardized and sex‐standardized mortality rate ratios for bleeding, myocardial infarction and stroke as causes of death were calculated in dialysis patients as compared with the European general population. Associations between potential risk factors and these causes of death in dialysis patients were investigated by calculating hazard ratios (HRs) with 95% confidence intervals (CIs) by the use of Cox proportional‐hazards regression.
Results
As compared with the general population, the age‐standardized and sex‐standardized mortality rate ratios in dialysis patients were 12.8 (95% CI 11.9–13.7) for bleeding as a cause of death (6.2 per 1000 person‐years among dialysis patients versus 0.3 per 1000 person‐years in the general population), 13.4 (95% CI 13.0–13.9) for myocardial infarction (22.5 versus 0.9 per 1000 person‐years), and 12.4 (95% CI 11.9–12.9) for stroke (14.3 versus 0.7 per 1000 person‐years).
Conclusion
Dialysis patients have highly increased risks of death caused by bleeding and arterial thrombosis as compared with the general population. Clinicians should be aware of the increased mortality risks caused by these conditions.
Keyword(s)
bleeding, dialysis, mortality, myocardial infarction, stroke
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