Consequences of hemolytic uremic syndrome among hemodialysis patients

Abstract

Background: Hemolytic uremic syndrome (HUS) is characterized by hemolytic anemia, low platelets, and renal impairment and is mediated by thrombotic microangiopathy (TMA). A common perception is that HUS becomes dormant in dialysis patients with end-stage renal disease (ESRD). We analyzed patients in a large dialysis organization to understand the potential consequences and burden of HUS. Methods: We identified patients with ESRD ascribed to HUS and those with ESRD ascribed to another cause (control patients) who received hemodialysis or peritoneal dialysis from 01 January 2007 to 31 December 2012. Outcomes were survival, hospitalization, and longitudinal laboratory values associated with TMA, including lactate dehydrogenase, red cell distribution width (RDW), platelets, and hemoglobin. Results: HUS patients (n = 217) were propensity-score matched 1:5 to control patients (n = 1,085) for age, gender, race, dry weight, insurance, access, comorbidities, and Charlson comorbidity index. Compared to control patients, HUS patients had significantly greater risk for hospitalizations overall (RR = 2.3, p = 0.004) and hospitalization for hematologic (RR = 5.6, p = 0.001), cardiovascular (RR = 2.1, p = 0.02), and pancreatic (RR = 7.9, p = 0.04) causes. HUS patients also had evidence of ongoing TMA: higher lactate dehydrogenase and RDW, lower platelets and hemoglobin, and more frequent lactate dehydrogenase spikes. Conclusions: Dialysis patients with HUS were at significantly higher risk than matched control patients for hospitalizations due to cardiovascular, hematologic, and pancreatic disease, which were associated with ongoing TMA. Additional studies are needed to determine whether targeted therapy for HUS reduces hospitalizations.