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Am J Kidney Dis. 2017 Aug;70(2):182-190. doi: 10.1053/j.ajkd.2016.10.039. Epub 2017 Jan 23.

Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.

Author information

1
Larner College of Medicine, University of Vermont, Burlington, VT. Electronic address: klcheung@med.uvm.edu.
2
Larner College of Medicine, University of Vermont, Burlington, VT.
3
University of Minnesota, Minneapolis, MN.
4
Geriatrics Research Education and Clinical Center, Stanford University and VA Palo Alto Health Care System, Palo Alto, CA.
5
University of California San Francisco, San Francisco, CA.
6
University of Alabama-Birmingham, Birmingham, AL.
7
University of Vermont, Burlington, VT.

Abstract

BACKGROUND:

Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks.

STUDY DESIGN:

Prospective cohort study.

SETTING & PARTICIPANTS:

30,239 black and white adults 45 years or older enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study 2003 to 2007.

PREDICTORS:

Estimated glomerular filtration rate (eGFR) using the combined creatinine-cystatin C (eGFRcr-cys) equation and urinary albumin-creatinine ratio (ACR).

OUTCOMES:

The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event.

RESULTS:

During 4.6 years of follow-up, 239 incident VTE events occurred over 124,624 person-years. Cause-specific HRs of VTE were calculated using proportional hazards regression adjusted for age, sex, race, region of residence, and body mass index. Adjusted VTE HRs for eGFRcr-cys of 60 to <90, 45 to <60, and <45 versus ≥90mL/min/1.73m2 were 1.28 (95% CI, 0.94-1.76), 1.30 (95% CI, 0.77-2.18), and 2.13 (95% CI, 1.21-3.76). Adjusted VTE HRs for ACR of 10 to <30, 30 to <300, and ≥300 versus <10mg/g were 1.14 (95% CI, 0.84-1.56), 1.15 (95% CI, 0.79-1.69), and 0.64 (95% CI, 0.25-1.62). Associations were similar for provoked and unprovoked VTE.

LIMITATIONS:

Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power.

CONCLUSIONS:

There was an independent association of low eGFR (<45 vs ≥90mL/min/1.73m2) with VTE risk, but no association of ACR and VTE.

KEYWORDS:

Chronic kidney disease (CKD); albumin-creatinine ratio (ACR); albuminuria; deep vein thrombosis and pulmonary embolus; glomerular filtration rate (GFR); kidney disease measures; race; renal insufficiency; vascular disease; venous thromboembolism (VTE)

PMID:
28126238
PMCID:
PMC5522772
[Available on 2018-08-01]
DOI:
10.1053/j.ajkd.2016.10.039
[Indexed for MEDLINE]

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