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Abstract: TH-PO378

Dialysis Modality and Bleeding Risk

Session Information

Category: Dialysis

  • 703 Dialysis: Peritoneal Dialysis

Authors

  • Ocak, Gurbey, University Medical Center Utrecht, Utrecht, Netherlands
  • Abrahams, Alferso C., University Medical Center Utrecht, Utrecht, Netherlands
  • Rookmaaker, Maarten B., University Medical Center Utrecht, Utrecht, Netherlands
  • Verhaar, Marianne C., University Medical Center Utrecht, Utrecht, Netherlands
  • Dekker, Friedo W., Leiden University Medical Center, Leiden, Netherlands
  • Van diepen, Merel, Leiden University Medical Center, Leiden, Netherlands
Background

Bleeding as a manifestation and complication of renal failure was already recognized in the 18th century. However, there is limited information whether bleeding risks are different for peritoneal dialysis patients and hemodialysis patients. From a clinical point of view, there could be a preferred dialysis modality for patients with bleeding problems. Therefore, the aim of this study was to investigate the association between dialysis modality and bleeding risk.

Methods

In total, 1745 incident dialysis patients from the NECOSAD study were prospectively followed for major bleeding events within three years of dialysis. Hazard ratios (HRs) with 95% confidence intervals (CIs) were calculated for hemodialysis as compared with peritoneal dialysis using Cox proportional hazard analyses. Hazard ratios were adjusted for age, sex, primary kidney disease, antiplatelet drug use, vitamin K antagonist use, EPO use, prior history of bleeding, cardiovascular disease, systolic blood pressure, residual GFR and albumin levels.

Results

Of the 1745 dialysis patients, 1211 started with hemodialysis and 534 started with peritoneal dialysis. A total of 183 patients had a bleeding event during a median follow-up of 2.2 years (interquartile range 1.0-3.0). The bleeding rate was 60.8 per 1000 person-years for hemodialysis patients and 34.6 per 1000 person-years for peritoneal dialysis patients. The crude hazard ratio of bleeding was 1.7 (95% CI 1.2-2.5) for hemodialysis patients as compared with peritoneal dialysis. Hemodialysis patients as compared with peritoneal dialysis patients had a 1.5-fold (95% CI 1.0-2.2) increased bleeding risk after adjustment for age, sex, primary kidney disease, prior history of bleeding and cardiovascular disease. After additional adjustment for antiplatelet drug use, vitamin K antagonist use, EPO use, systolic blood pressure, residual GFR and albumin levels, the HR did not change 1.5 (95% CI 1.0-2.4).

Conclusion

In this large prospective cohort of incidence dialysis patients with detailed information, hemodialysis as compared with peritoneal dialysis was associated with an increased bleeding risk. An explanation could be the use of heparin for hemodialysis sessions to prevent clotting of dialysis lines and dialyzers. Future studies should examine whether starting or switching to peritoneal dialysis could be beneficial for patients with bleeding problems.