title: Thrombophilia and the risk for hemodialysis vascular access thrombosis.
abstract: Vascular access thrombosis is the most common and costly complication in hemodialysis patients. The role of thrombophilia in access thrombosis is not established. A case-control study was conducted of 419 hemodialysis patients to determine whether thrombophilia was associated with arteriovenous fistula or graft thrombosis. Participants were enrolled from three in-center and five satellite dialysis units associated with a Canadian academic health science center that provides dialysis services in a catchment area of one million. Patients were tested for factor V Leiden, prothrombin gene mutation, factor XIII genotype, methylenetetrahydrofolate reductase genotype, lupus anticoagulant, anticardiolipin antibody, factor VIII, homocysteine, and lipoprotein (a) concentrations. Overall, 59 (55%) patients with access thrombosis had at least one thrombophilia compared with 122 (39%) patients without access thrombosis (unadjusted odds ratio [OR], 1.91; 95% confidence interval [CI], 1.23 to 2.98). After controlling for important risk factors, the association between any thrombophilia and access thrombosis remained (adjusted OR, 2.42; 95% CI, 1.47 to 3.99). For each additional thrombophilic disorder, the odds of access thrombosis increased significantly (adjusted OR, 1.87; 95% CI, 1.34 to 2.61). This study suggests that thrombophilia is associated with access thrombosis in dialysis patients. Large, multicenter, prospective cohort studies are needed to confirm the observations from this case-control study.
authors.affiliation: Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada K1H 7W9. gknoll@ottawahospital.on.ca
authors.forename: Greg A
authors.initials: GA
authors.lastname: Knoll
authors.forename: Philip S
authors.initials: PS
authors.lastname: Wells
authors.forename: Darlene
authors.initials: D
authors.lastname: Young
authors.forename: Sherry L
authors.initials: SL
authors.lastname: Perkins
authors.forename: Rachel M
authors.initials: RM
authors.lastname: Pilkey
authors.forename: Jennifer J
authors.initials: JJ
authors.lastname: Clinch
authors.forename: Marc A
authors.initials: MA
authors.lastname: Rodger
mesh_terms: D000368:Aged; D001166:Arteriovenous Shunt, Surgical / Q000009:adverse effects*; D016022:Case-Control Studies; D016001:Confidence Intervals; D005260:Female; D006083:Graft Occlusion, Vascular / Q000209:etiology*; D006801:Humans; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis / Q000009:adverse effects*; D012307:Risk Factors; D019851:Thrombophilia / Q000150:complications*; D013927:Thrombosis / Q000209:etiology*