Vascular complications in kidney disease

Abstract

The main objectives of this thesis were to investigate the association between kidney disease and venous and arterial thrombosis and to provide insight in the mechanism of the association between kidney disease and thrombosis. Furthermore, the mortality risks for hemodialysis patients with catheter, fistula and graft vascular accesses were investigated. Our studies showed that kidney disease was associated with an increased risk of venous thrombosis. We showed that patients with chronic kidney disease stages 1__3 (early stages) had an almost 2-fold increased risk of venous thrombosis as compared with subjects without chronic kidney disease. We also showed that patients with a severely decreased kidney function (estimated glomerular filtration rate <30 ml/min) had a 6-fold increased risk of venous thrombosis as compared with persons with a normal kidney function. Furthermore, it was shown that dialysis patients have increased risks of myocardial infarction and ischemic stroke. Dialysis patients with a catheter had increased mortality risks as compared with dialysis patients with an arteriovenous access (fistula or graft). An important mechanism for the increased thrombosis risk in patients with a kidney disease could be hypercoagulability (increased factor VIII and von Willebrand factor levels).