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Am J Kidney Dis. 2017 Dec;70(6):826-833. doi: 10.1053/j.ajkd.2017.07.003. Epub 2017 Aug 18.

Risk of Venous Thromboembolism in Patients by Albuminuria and Estimated GFR.

Author information

1
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada.
2
Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada.
3
Division of Hematology, Department of Medicine, Western University, London, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
4
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, Department of Medicine, McMaster University, Hamilton, Ontario, Canada.
5
Division of Nephrology, University of Alberta, Edmonton, Alberta, Canada.
6
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada.
7
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, London Health Sciences Centre, Western University, London, Ontario, Canada.
8
Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; Division of Nephrology, St. Michael's Hospital, University of Toronto, Toronto, Ontario, Canada.
9
Division of Nephrology, Department of Medicine, University of Ottawa, Ottawa, Ontario, Canada; Epidemiology, Ottawa Hospital Research Institute, Ottawa, Ontario, Canada; Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada. Electronic address: msood@toh.on.ca.

Abstract

BACKGROUND:

The risk for venous thromboembolism (VTE) is elevated with albuminuria or a low estimated glomerular filtration rate (eGFR). However, the VTE risk due to the combined effects of eGFR and albuminuria are unknown.

STUDY DESIGN:

Population-based cohort study.

SETTINGS & PARTICIPANTS:

694,956 adults in Ontario, Canada, from 2002 to 2012.

FACTORS:

eGFR and albumin-creatinine ratio (ACR).

OUTCOME:

VTE.

RESULTS:

15,180 (2.2%) VTE events occurred during the study period. Both albuminuria and eGFR were independently associated with VTE. The association of albuminuria and VTE differed by level of eGFR (P for ACR × eGFR interaction < 0.001). After considering the competing risk for death, there was a 61% higher rate of VTE in patients with normal eGFRs (eGFRs>90mL/min/1.73m2) and heavy albuminuria (ACR>300mg/g) compared with those with normal eGFRs and no albuminuria (subdistribution HR, 1.61; 95% CI, 1.38-1.89). Among those with reduced kidney function (eGFR, 15-29mL/min/1.73m2), the risk for VTE was only minimally increased, irrespective of albuminuria (subdistribution HRs of 1.23 [95% CI, 1-1.5] and 1.09 [95% CI, 0.82-1.45] for ACR<30 and >300mg/g, respectively).

LIMITATIONS:

Only single determinations of ACR and eGFR were used. Diagnostic/International Classification of Diseases codes were used to define VTE.

CONCLUSIONS:

Albuminuria increases the risk for VTE markedly in patients with normal eGFRs compared with those with lower eGFRs.

KEYWORDS:

Venous thromboembolism (VTE); albuminuria; chronic kidney disease (CKD); decreased kidney function; deep vein thrombosis; estimated glomerular filtration rate (eGFR); kidney failure; kidney function; proteinuria; pulmonary embolism

PMID:
28823585
DOI:
10.1053/j.ajkd.2017.07.003
[Indexed for MEDLINE]

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