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.
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.
Authors: J Bradley Layton; Susan L Hogan; Caroline E Jennette; Barbara Kenderes; Jenna Krisher; J Charles Jennette; William M McClellan Journal: Clin J Am Soc Nephrol Date: 2010-08-05 Impact factor: 8.237
Authors: George K Bertsias; Maria Tektonidou; Zahir Amoura; Martin Aringer; Ingeborg Bajema; Jo H M Berden; John Boletis; Ricard Cervera; Thomas Dörner; Andrea Doria; Franco Ferrario; Jürgen Floege; Frederic A Houssiau; John P A Ioannidis; David A Isenberg; Cees G M Kallenberg; Liz Lightstone; Stephen D Marks; Alberto Martini; Gabriela Moroni; Irmgard Neumann; Manuel Praga; Matthias Schneider; Argyre Starra; Vladimir Tesar; Carlos Vasconcelos; Ronald F van Vollenhoven; Helena Zakharova; Marion Haubitz; Caroline Gordon; David Jayne; Dimitrios T Boumpas Journal: Ann Rheum Dis Date: 2012-07-31 Impact factor: 19.103