From the Research
Chronic kidney disease (CKD) does increase the risk of developing deep vein thrombosis (DVT) and pulmonary embolism (PE), with a 1.5 to 5.5 times higher risk compared to those with normal kidney function, as demonstrated in a study published in 2013 1. The risk appears to increase as kidney function declines, with end-stage renal disease (ESRD) patients on dialysis having the highest risk. This elevated risk stems from several factors associated with CKD, including increased levels of procoagulant factors, decreased levels of anticoagulant proteins, endothelial dysfunction, chronic inflammation, and elevated fibrinogen levels. Some key points to consider:
- A study from 2017 found that acute kidney injury (AKI) also increases the risk of DVT and PE, with a 1.44-fold and 1.49-fold increase in risk within 3 and 5 years, respectively 2.
- Another study from 2008 highlighted the importance of identifying high-risk groups, such as those with CKD and concomitant congestive heart failure, surgery, or thrombophilia, who may benefit from personalized prevention strategies 3.
- The role of gut-microbiota metabolism and uremic toxins in inducing a prothrombotic phenotype in CKD patients has also been explored, with potential targets for prevention and treatment of thromboembolic events 4.
- When it comes to anticoagulation therapy, the use of direct oral anticoagulants (DOACs) in patients with stage 5 CKD or ESKD should be individualized, with apixaban or rivaroxaban considered for stroke prevention in atrial fibrillation, but not recommended over warfarin for venous thromboembolism (VTE) 5. Overall, CKD patients require careful monitoring and management of their thrombotic risk factors, particularly during hospitalization or periods of reduced mobility.