Thrombophilia and the risk for hemodialysis vascular access thrombosis.
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.
Knoll
Greg A
GA
Division of Nephrology, Department of Medicine, University of Ottawa, Ontario, Canada K1H 7W9. gknoll@ottawahospital.on.ca
Wells
Philip S
PS
Young
Darlene
D
Perkins
Sherry L
SL
Pilkey
Rachel M
RM
Clinch
Jennifer J
JJ
Rodger
Marc A
MA
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*