From the Guidelines
D-dimer levels should be interpreted with caution in patients with end-stage renal disease (ESRD), considering a higher threshold or age-adjusted values due to reduced specificity and potential for unnecessary imaging studies. In ESRD patients, the kidneys' reduced ability to clear D-dimer leads to its accumulation in the bloodstream, resulting in elevated levels even in the absence of thrombotic events 1. This elevation is further complicated by chronic inflammation and increased coagulation activity commonly seen in ESRD patients. Key considerations for clinicians interpreting D-dimer results in this population include:
- Clinical presentation
- Pre-test probability for thrombotic disorders
- Trending of D-dimer values over time, rather than relying on a single measurement Alternative diagnostic approaches, such as ultrasound or CT angiography, may be necessary for a definitive diagnosis of thrombotic conditions in ESRD patients. The association between impaired renal function and increased cardiovascular disease (CVD) risk, as seen in ESRD patients, underscores the importance of careful diagnostic evaluation and management strategies in this high-risk population 1.
From the Research
D-Dimer and End-Stage Renal Disease
- D-Dimer levels are often elevated in patients with end-stage renal disease (ESRD) due to renal dysfunction 2
- Renal dysfunction can lead to increased D-Dimer levels, making it challenging to diagnose thromboembolic disease in patients with ESRD 2
- Adjusted D-Dimer cutoff levels based on estimated glomerular filtration rate (eGFR) have been suggested to improve the diagnosis of thromboembolic disease in patients with ESRD 2
Antithrombotic Therapy in ESRD
- Patients with ESRD are at increased risk of thrombosis and bleeding, making antithrombotic therapy a complex decision 3, 4, 5
- Antithrombotic medications, such as anticoagulants and antiplatelet agents, are often used in patients with ESRD to prevent thromboembolic events, but their use is associated with an increased risk of bleeding 3, 4, 5
- The decision to use antithrombotic therapy in patients with ESRD should be individualized and based on careful clinical judgment, taking into account the patient's underlying risk factors and comorbidities 3, 4, 5
Management of ESRD
- Patients with ESRD require comprehensive management, including dialysis, transplantation, and medical therapy to control blood pressure, diabetes, and other comorbidities 6
- Vaccination against seasonal influenza, tetanus, hepatitis B, human papillomavirus, and Streptococcus pneumoniae is recommended for patients with ESRD 6
- Clinicians should be aware of the many medical complications associated with ESRD, including cardiovascular disease, infection, and malnutrition 6