Major adverse thrombotic events and bleeding in stage 4 and 5 chronic kidney disease and dialysis-dependent end-stage kidney disease.

Background: Balancing the risks of thrombotic and bleeding events in people with advanced kidney disease is a clinical challenge.

Objectives: To estimate rates of major adverse thrombotic events (MATEs) and bleeding events in individuals with chronic kidney disease (CKD) stage 4 or 5 or with end-stage kidney disease receiving hemodialysis (HD) or peritoneal dialysis (PD).

Methods: Using administrative claims from a 20% Medicare sample, Optum's deidentified Clinformatics Data Mart database, and the United States Renal Data System from 2016 to 2019, we identified individuals with CKD stages 4 or 5 and individuals with dialysis-dependent end-stage kidney disease. During follow-up (3 years maximum), we estimated incidence rates of MATEs (a composite of myocardial infarction, ischemic stroke, systemic embolism, deep vein thrombosis, pulmonary embolism, and critical limb ischemia events) and bleeding events (including major and clinically relevant nonmajor bleeding) using Poisson regression.

Results: Among older adults insured by fee-for-service Medicare, incidence rates of MATEs for stages 4 and 5 CKD were 8.7 and 10.4 per 100 person-years, respectively; those for HD and PD were 13.5 and 14.3 per 100 person-years, respectively. Incidence rates of bleeding events were 13.8 (stage 4 CKD), 16.8 (stage 5 CKD), 21.7 (HD), and 20.2 (PD) per 100 person-years. Rates of MATEs and bleeding events in individuals with CKD insured by Medicare Advantage or commercial insurance followed similar patterns but were lower.

Conclusion: Rates of MATEs and bleeding events increased with greater severity of kidney disease, illustrating the difficulty associated with balancing the management of these events in populations at high risk for both.