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Nephrol Dial Transplant. 2006 Jan;21(1):191-6. Epub 2005 Oct 4.

Thrombotic microangiopathy in United States long-term dialysis patients.

Author information

1
Nephrology Service, Walter Reed Army Medical Center, Washington, DC 20307-5001, and Uniformed Services University of the Health Sciences, Bethesda, MD, USA. robert.perkins@na.amedd.army.mil

Abstract

BACKGROUND:

The incidence, risk factors, recurrence rates and prognosis of thrombotic microangiopathy (TMA) among long-term dialysis patients in the United States have not been previously described in a national population.

METHODS:

272 024 Medicare primary patients in the United States Renal Data System (USRDS) initiated on end-stage renal disease (ESRD) therapy between 1 April 1995 and 31 December 1999 with Medicare as primary payer were analysed in a retrospective cohort study of USRDS of TMA. Cox regression was used to calculate adjusted hazard ratios (AHR) for risk of TMA and risk of death after TMA.

RESULTS:

The incidence of TMA in the first year of dialysis was 0.5% overall. Among patients with renal failure due to haemolytic uraemic syndrome (HUS), the incidence of TMA was highest in the first year of dialysis (HUS, 11.3% first year, 4.5% per year thereafter), while among patients without HUS the incidence of TMA was much lower and more constant over time (0.3% per year). In Cox regression analysis, independent risk factors for TMA were renal failure due to HUS (adjusted hazard ratio (AHR) 179, 95% CI 95-338), paediatric age (<or=18 years vs older, AHR 2.59, 95% CI 1.48-4.55), female gender (AHR 1.99, 95% CI 1.43-2.78), and systemic lupus erythematosus (SLE, AHR 3.66, 95% CI 1.49-8.51). One-year survival after TMA was poor at 58% (AHR for mortality 2.04, 95% CI 1.23-3.38).

CONCLUSIONS:

TMA is an uncommon cause of hospitalization after dialysis, but does recur in patients with HUS at a substantial rate. Younger age and SLE were risk factors for new onset TMA, which was associated with poor survival. Vigilant monitoring of select patients with HUS-related ESRD and higher-risk patients with SLE is warranted in the dialysis population.

PMID:
16204286
DOI:
10.1093/ndt/gfi153
[Indexed for MEDLINE]

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