Patients with end-stage kidney disease initiating dialysis may face an increased risk of pulmonary embolism, with a 1-year incidence of 0.84% (942 per 100,000 person-years), according to a retrospective analysis of the U.S. Renal Data System.
In the study, published in JAMA Network Open, investigators analyzed data from 2011 to 2019 and found a slight increase in pulmonary embolism (PE) incidence over time (P = .05).
In-hospital mortality among patients with end-stage kidney disease (ESKD) hospitalized for PE was 13.7%, whereas postdischarge 30-day mortality was 13.1%. Among the 2,025 patients who survived hospitalization, the 1-year recurrence rate was 4.1%.
Despite the high recurrence risk, anticoagulation (AC) therapy was underutilized—only 41% of the 1,454 patients with Medicare Part D coverage filled an AC prescription. PE recurrence rates were similar between the patients who received AC and those who didn't (4.2% vs 2.8%, P = .11). Meanwhile, inferior vena cava filter use declined from 12.6% in 2011 to 5.1% in 2019 (P < .001).
Patients on peritoneal dialysis (PD) had a lower 1-year PE incidence compared with those on hemodialysis (HD) (hazard ratio = 0.68, 95% confidence interval = 0.58–0.80, P < .001), though in-hospital and 30-day mortality rates were similar between modalities.
These findings highlighted the complexity of anticoagulation management in patients with ESKD and PE.
"Patients receiving PD had a significantly lower 1-year PE incidence than those receiving HD, even after adjusting for confounders. The mechanism of this finding remains unclear and warrants further investigation," said lead study author Kunal N. Patel, MD, MPH, of the Department of Cardiovascular Medicine at the University of Kansas Medical Center, and colleagues.
Study limitations included reliance on administrative data, potential miscoding, and the exclusion of younger patients without Medicare, which may have affected generalizability. Further research is needed to refine anticoagulation strategies and improve PE outcomes in patients with ESKD.
Full disclosures are available in the published study.
