title: Risk of pulmonary embolism in patients with end-stage renal disease receiving long-term dialysis.
abstract: BACKGROUND
  This study compared the pulmonary embolism (PE) risks between Asian dialysis patients and a comparison cohort without clinical kidney disease.
  
  
  METHODS
  From the National Health Insurance claims data of Taiwan, we identified 106 231 newly diagnosed end-stage renal disease patients undergoing dialysis in 1998-2010 and randomly selected 106 231 comparison subjects, frequency matched by age, sex and the index year. We further selected 7430 peritoneal dialysis (PD) patients and 7340 propensity score-matched hemodialysis (HD) patients. Incidence rates and hazard ratios (HRs) of PE and odds ratio (OR) of subsequent 30-day deaths from PE were evaluated among study cohorts by the end of 2011.
  
  
  RESULTS
  The overall incident PE was nearly 3-fold greater in dialysis patients than in the comparison cohort (0.92 versus 0.33 per 1000 person-years), with an adjusted HR of 2.02 [95% confidence interval (CI) = 1.63-2.50]. The PE incidence was greater in the propensity score-matched HD patients, than in PD patients with an adjusted HR of 2.30 (95% CI = 1.23-4.29). There was a greater PE risk for central venous catheter users than non-users among HD patients (1.83 versus 0.75 per 1000 person-years). The 30-day mortality from PE was higher in dialysis patients than in the comparison cohort (16.5 versus 9.77%) with an adjusted OR of 2.56 (95% CI = 1.32-4.95).
  
  
  CONCLUSIONS
  Dialysis patients are at a nearly 2-fold increased hazard of developing PE and are at greater risk of fatality from PE compared with those without clinical kidney disease. This study also shows a higher PE risk in HD patients than in PD patients.
authors.affiliation: Graduate Institute of Clinical Medical Science, China Medical University, Taichung, Taiwan.|Department of Internal Medicine, College of Medicine, China Medical University, Taichung, Taiwan.|Division of Nephrology, China Medical University Hospital, Taichung, Taiwan.
authors.forename: I-Kuan
authors.initials: IK
authors.lastname: Wang
authors.affiliation: Division of Pulmonary and Critical Care Medicine, Department of Internal Medicine, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Te-Chun
authors.initials: TC
authors.lastname: Shen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.
authors.forename: Chih-Hsin
authors.initials: CH
authors.lastname: Muo
authors.affiliation: Division of Nephrology, Chang Gung Memorial Hospital, Taipei, Taiwan.|Chang Gung University College of Medicine, Taoyuan, Taiwan.
authors.forename: Tzung-Hai
authors.initials: TH
authors.lastname: Yen
authors.affiliation: Management Office for Health Data, China Medical University Hospital, Taichung, Taiwan.|Department of Health Services Administration, College of Public Health, China Medical University, Taichung, Taiwan.
authors.forename: Fung-Chang
authors.initials: FC
authors.lastname: Sung
mesh_terms: D000328:Adult; D000368:Aged; D005260:Female; D006801:Humans; D015994:Incidence; D007676:Kidney Failure, Chronic / Q000150:complications* / Q000628:therapy; D008297:Male; D008875:Middle Aged; D011655:Pulmonary Embolism / Q000453:epidemiology / Q000209:etiology* / Q000473:pathology; D006435:Renal Dialysis / Q000009:adverse effects*; D012189:Retrospective Studies; D012307:Risk Factors; D013624:Taiwan / Q000453:epidemiology; D055815:Young Adult
keywords: end-stage renal disease; hemodialysis; mortality; peritoneal dialysis; pulmonary embolism