Deep vein thrombosis in patients with chronic kidney disease.
Deep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome. We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p < 0.0001), more often African-American (p < 0.0001), and more often Hispanic (p = 0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p = 0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p = 0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p < 0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p = 0.003) and difficulty ambulating (5.4% vs. 10.1%, p = 0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p = 0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.
Daneschvar
H Leon
HL
Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Seddighzadeh
Ali
A
Piazza
Gregory
G
Goldhaber
Samuel Z
SZ
D000328:Adult; D001741:Black or African American / Q000706:statistics & numerical data; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D003430:Cross-Sectional Studies; D005343:Fibrinolytic Agents / Q000627:therapeutic use; D006333:Heart Failure / Q000150:complications; D006630:Hispanic or Latino / Q000706:statistics & numerical data; D006801:Humans; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000208:ethnology / Q000628:therapy; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications* / Q000208:ethnology; D016017:Odds Ratio; D011446:Prospective Studies; D012042:Registries; D006435:Renal Dialysis; D018570:Risk Assessment; D012307:Risk Factors; D013514:Surgical Procedures, Operative / Q000009:adverse effects; D014463:Ultrasonography; D014481:United States; D020246:Venous Thrombosis / Q000000981:diagnostic imaging / Q000208:ethnology / Q000209:etiology* / Q000517:prevention & control
D005343:Fibrinolytic Agents