title: D-dimer levels in maintenance hemodialysis patients: High prevalence of positive values also in the group without predisposing diseases.
abstract: We aimed to estimate the prevalence of elevated D-dimer levels in all chronic hemodialysis patients and those without additional disease, and to identify factors associated with increased D-dimer. In 167 chronic hemodialysis patients from our center, D-dimer was measured before dialysis. The effects of age, C-reactive protein (CRP), recent acute illness, vascular access, anticoagulation type, dialysis vintage, and chronic diseases, considered to predispose for increased D-dimer levels, were analyzed. The median D-dimer in the whole group was 966 (inter-quartile range [IQR] 524-1947) μg/L and was positive (>500 μg/L) in 75% of cases. D-dimer was positive in 91% of patients with acute illness, 76% of those with predisposing chronic diseases, but was still positive in 52% of patients without additional disease (i.e., acute illness or predisposing chronic diseases) - median D-dimer was 538.5 (IQR 359-966) μg/L. D-dimer was correlated to patients' age, but not dialysis vintage. In univariate analysis, the D-dimer levels were significantly higher in patients with atrial fibrillation, ischemic heart disease, recent acute illness, increased CRP, dialyzed over a catheter, and on citrate anticoagulation. Multivariate logistic regression showed that only age >65 years (odds ratio [OR] 2.93), catheter (OR 4.86), and positive CRP (OR 4.07) were independently associated with positive D-dimer at 500 μg/L cut-off, while the significance of age disappeared at 2000 μg/L cut-off. To conclude, the high prevalence of positive D-dimer values even in hemodialysis patients without additional disease limits the use of D-dimer for exclusion of thromboembolic diseases in hemodialysis patients.
authors.affiliation: Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Jakob
authors.initials: J
authors.lastname: Gubensek
authors.affiliation: Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Matea
authors.initials: M
authors.lastname: Lolic
authors.affiliation: Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Rafael
authors.initials: R
authors.lastname: Ponikvar
authors.affiliation: Department of Nephrology, University Medical Center Ljubljana, Ljubljana, Slovenia.|Faculty of Medicine, University of Ljubljana, Ljubljana, Slovenia.
authors.forename: Jadranka
authors.initials: J
authors.lastname: Buturovic-Ponikvar
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D002097:C-Reactive Protein / Q000032:analysis*; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D006801:Humans; D008297:Male; D008875:Middle Aged; D015995:Prevalence; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D055815:Young Adult
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D002097:C-Reactive Protein
keywords: D-dimer; cut-off value; end-stage renal disease; hemodialysis; prevalence; thromboembolic disease