OC 45.3 - Major Bleeding Event Rates in Patients on Hemodialysis and Peritoneal Dialysis: Results from the International DOPPS and PDOPPS

Monday, June 26, 2023

15:15 – 15:30 ET

Room: 511

Session Available As: On-Demand

Co-Author(s)

MG

Murilo Guedes

Research Scientist
Arbor Research Collaborative for Health
Ann Arbor, Michigan, United States
JZ

Junhui Zhao

Senior Research Analyst
Arbor Research Collaborative for Health
Ann Arbor, Michigan, United States
CC

Catelyn Coyle

Associate Principal Scientist
Merck & Co., Inc.
Rahway, New Jersey, United States
LB

Lori D. Bash

Sr. Director, Outcomes Research
Merck & Co., Inc.
Rahway, New Jersey, United States
DR

Dena Ramey

Sr. Principal Scientist, Epidemiology
Merck & Co., Inc.
West Point, Pennsylvania, United States
GA

G. Brandon Atkins

Distinguished Scientist
Merck and Co., Inc.
Rahway, New Jersey, United States
DJ

David Johnson

Professor
Department of Kidney and Transplant Services, University of Queensland at Princess Alexandra Hospital
Brisbane, Queensland, Australia
AV

Almudena Vega

Associate Professor
Hospital Universitario Infanta Leonor: Hospital Infanta Leonor
Madrid, Madrid, Spain
PU

Pablo Urena

Director
AURA Nord Saint Ouen
Saint Ouen, Ile-de-France, France
PM

Pietro Manuel Ferraro

Associate Professor
Università Cattolica del Sacro Cuore
Rome, Lazio, Italy
MA

Mohammed Al Ghonaim

Professor
Medicine Department, Saudi Center for Organ Transplantation, King Saud University
Riyadh, Ar Riyad, Saudi Arabia

Presenting Author(s)

Marc P. Bonaca, MD MPH FAHA FACC (he/him/his)

Professor of Medicine, Director of Vascular Research
University of Colorado School of Medicine
Aurora, Colorado, United States

Co-Author(s)

RP

Roberto Pecoits-Filho

DOPPS Program Scientific Director
Arbor Research Collaborative for Health
Ann Arbor, Michigan, United States
AK

Angelo Karaboyas

Research Scientist
Arbor Research Collaborative for Health
Ann Arbor, Michigan, United States

Background: The rates of major bleeding events in a global population receiving hemodialysis (HD) and peritoneal dialysis (PD) remain unknown.

Aims: To describe rates of bleeding leading to death or hospitalization in patients with end-stage kidney disease (ESKD), stratified by dialysis modality, international region, and other risk factors.

Methods: This analysis includes data from 21 countries in the Dialysis Outcomes and Practice Patterns Study (DOPPS) phases 4-7 (2009-2022) and eight countries in the Peritoneal DOPPS (PDOPPS) phases 1-2 (2014-2022), prospective cohort studies of adults treated with HD and PD, respectively. Patient characteristics and prescriptions were measured at baseline, and prospective follow-up captured death, including primary cause and time to inpatient hospitalizations. Rates for the primary outcome of the first major bleeding event (i.e., leading to death or hospitalization) were calculated as events per 100 person-years.

Results: We included 38,509 adults (84% HD, 16% PD) across Europe (44%), Australia-New Zealand (4%), other Asia-Pacific (33%), North America (16%), and the Gulf Cooperation Council (GCC; 3%). A greater proportion of those on HD (vs. PD) had cardiovascular-related comorbidities and prescriptions for anti-thrombotic agents and proton-pump inhibitors (Table 1). The rate of the primary outcome was 4.5 (95% confidence interval 4.3, 4.7) per 100 person-years in the overall population. Gastrointestinal bleeding was the most common cause of bleeding events requiring hospitalization; hemorrhagic stroke was the leading cause of fatal bleeding events (Table 2). Individuals prescribed (vs. not) anti-platelet agents (9%) or anticoagulants (9%) had higher rates of bleeding events.

Conclusion(s): The rate of major bleeding events in patients with ESKD is high. Patients prescribed anticoagulants had approximately a two-fold higher rate of bleeding than those not on anticoagulants and 1.5-fold those on antiplatelets. Newer anticoagulants that are efficacious but with reduced risk of high-risk bleeding events are warranted in ESKD.

Learning Objectives:

At the conclusion of this presentation, participants will be able to: Describe baseline characteristics in a global cohort of patients with end stage kidney disease
At the conclusion of this presentation, participants will be able to: Describe risk of major and non-major bleeding events among patients with end-stage kidney disease (ESKD) in a global setting
At the conclusion of this presentation, participants will be able to: Describe baseline characteristics associated with higher bleeding risks in patients wtih end-stage kidney disease