OC 21.1 - Venous thromboembolism and vascular access thrombosis in patients with end-stage kidney disease on hemodialysis: Prospective results from the VIVALDI study

Sunday, June 25, 2023

14:45 – 15:00 ET

Room: 516

Session Available As: Live-Stream and On-Demand

Co-Author(s)

OK

Oliver Königsbrügge

Resident physician
Medical University of Vienna
Vienna, Wien, Austria

Co-Author(s)

RK

Renate Klauser-Braun

Head of Department
Clinic Donaustadt
Vienna, Wien, Austria
SS

Sabine Schmaldienst

Head of Department
Clinic Favoriten
Vienna, Wien, Austria
ML

Matthias Lorenz

Medical Doctor
Vienna Dialysis Center, Vienna, Austria
Vienna, Wien, Austria
Ingrid Pabinger, MD

Co-Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Hematology and Hemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria
MS

Marcus Säemann

Head of Department
Clinic Ottakring
Vienna, Wien, Austria

Presenting Author(s)

Cihan Ay, MD (he/him/his)

Professor, Head of the Thrombosis and Haemostasis Research Group
Clinical Division of Haematology and Haemostaseology, Department of Medicine I, Medical University of Vienna, Vienna, Austria
Vienna, Wien, Austria

Background: Venous thromboembolism (VTE) of the upper extremities and vascular access thrombosis (VAT) cause significant burden to patients with end-stage kidney disease on hemodialysis (HD) because they can lead to missed HD sessions, need for intervention, and require antithrombotic treatment.

Aims: To capture the incidence of VTE and VAT events in HD patients, risk factors for their occurrence, and antithrombotic treatment.

Methods: Prevalent patients on HD were recruited into a population-based prospective cohort study after informed consent. VTE and vascular access thrombosis events were recorded during follow-up. The study was approved by the local ethics committee.

Results: 625 patients (231 women, median age 66 years) were included for a median observation time of 870 days (IQR, 391-1234 days). VTE occurred in 24 patients (3.8%), including 20 deep vein thrombosis and 7 pulmonary emboli, and VAT occurred in 97 patients (15.5%). Incidence rates were 1.73 per 100 patient-years for VTE and 7.63 per 100 patient-years for VAT. The 30-day-case-fatality rate was 16.7% for VTE and 4.1% for VAT.
Increasing age and presence of atrial fibrillation (AF) were significantly associated with occurrence of VTE (table 1). The association of VTE with AF was attenuated after multivariable adjustment for age, sex, and anticoagulation. Prior history of myocardial infarction was significantly associated with a reduced risk of VAT (HR 0.43, 95% confidence interval [CI] 0.21-0.86, p=0.017), adjusted for age, sex, antiplatelet and anticoagulation treatment.
The occurrence of VTE was significantly associated with an increased risk of subsequent major bleeding occurrence (HR 3.25, 95% CI 1.71-6.10, p< 0.001) while there was no significant association with the occurrence of ischemic stroke, myocardial infarction, cardiovascular- or all-cause death (table 2).

Conclusion(s): Increasing age is associated with reduced risk of VTE in patients on HD, and VTE events increase the risk of major bleeding events. VAT is a frequent complication in HD patients.

Learning Objectives:

Rate of VTE in patients with end stage kidney disease on hemodialysis
Rate of vascular access thrombosis in patients with end stage kidney disease on hemodialysis
Risk factors for VTE and vascular access thrombosis in patients with end stage kidney disease on hemodialysis