Risk of Venous Thromboembolism in Patients by Albuminuria and Estimated GFR

Massicotte‐Azarniouch, David; Eddeen, Anan Bader; LazoLanger, Alejandro; Molnar, Amber O.; Lam, Ngan N.; McCallum, Megan K.; Bota, Sarah E.; Zimmerman, Deborah; Garg, Amit X.; Harel, Ziv; Perl, Jeffery; Wald, Ron; Sood, Manish M.

doi:10.1053/j.ajkd.2017.07.003

Cited by 22 publications

(20 citation statements)

References 31 publications

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“…Risk of VTE is also increased with lower eGFR and higher albuminuria in patients with CKD. 3 , 5 , 34 Cheung et al reported that the risk of VTE increased more than 2-fold in patients with eGFR <45 mL/min/1.73 m 2 compared to patients with eGFR ≥90 mL/min/1.73 m 2 . 34 In another Canadian study, the risk of VTE progressively increased with worsening albuminuria, but this effect was attenuated in lower eGFR categories such that at <60 mL/min/1.73 m 2 , worsening albuminuria had no effect on VTE risk.…”

Section: Discussionmentioning

confidence: 99%

“…Patients with chronic kidney disease (CKD) are also at an increased risk of hemorrhage and VTE, and lower estimated glomerular filtration rate (eGFR) and heavier albuminuria have been associated with this increased risk. 3 - 5 Lower eGFR and heavier albuminuria in the non-transplant population have been independently associated with other important outcomes including mortality, kidney replacement therapy (KRT), and cardiovascular events. 6 - 10 We have shown similar associations in the kidney transplant population.…”

Section: Introductionmentioning

confidence: 99%

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Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation

Jeong

Quinn

Ravani

et al. 2020

Can J Kidney Health Dis

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Background: Compared to the general population, kidney transplant recipients are at increased risk of hemorrhage and thrombosis. Whether this risk is affected by graft function and albuminuria is unknown. Objective: To determine the association between graft function and albuminuria and the risk of post-transplant hemorrhage and thrombosis. Design: Retrospective cohort study. Setting: We used linked health care databases in Alberta, Canada. Patients/sample/participants: We included adult kidney transplant recipients from 2002 to 2015 with a functioning graft at 1 year. Measurements: Estimated glomerular filtration rate (eGFR) and albuminuria measurements at 1 year post-transplant were used to categorize recipients (eGFR: ≥45 vs. <45 mL/min/1.73 m2; albuminuria: absence vs. presence). We determined the rates of post-transplant hemorrhage and venous thrombosis based on validated diagnostic and procedural codes. Methods: We determined the association between categories of eGFR and albuminuria and post-transplant hemorrhage and venous thrombosis using Poisson regression with log link. Results: Of 1284 kidney transplant recipients, 21% had an eGFR <45 mL/min/1.73 m2 and 40% had presence of albuminuria at 1 year post-transplant. Over a median follow-up of 6 years, there were 100 hemorrhages (12.6 events per 1000 person-years) and 57 venous thrombosis events (7.1 events per 1000 person-years). The age- and sex-adjusted rate of hemorrhage and thrombosis was over 2-fold higher in recipients with lower eGFR and presence of albuminuria compared to higher eGFR and no albuminuria (hemorrhage: incidence rate ratio, IRR, 2.6, 95% confidence interval [CI]: 1.5-4.4, P = .001; thrombosis: IRR, 2.3, 95% CI: 1.1-5.0, P = .046). Limitations: Complete relevant medication information, such as anticoagulants, were not available in our datasets. Due to sample size, this study was underpowered to conduct a fully adjusted analysis. Conclusion: Among kidney transplant recipients, lower eGFR and presence of albuminuria at 1 year post-transplant were associated with an over 2-fold higher risk of hemorrhage and venous thrombosis. Graft function and albuminuria at 1 year post-transplant are important prognostic factors in determining risk of post-transplant hemorrhage and venous thrombosis. Further research, including medication data, are needed to further delineate outcomes and safety. Trial registration: Not applicable (cohort study).

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Section: Discussionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation

Jeong

Quinn

Ravani

et al. 2020

Can J Kidney Health Dis

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“…A population-based cohort study in Canada also demonstrated that the adjusted HR for death increased with higher albumin-creatinine ratio and lower eGFR category [21]. In several studies of PE outcomes, eGFR has been assessed using a single creatinine measurement [13, 19-21]; however, patients with acute PE may experience a transient decline of renal function, which improves during treatment. We attempted to group patients according to either transient or maintained nature of the decline of their renal function.…”

Section: Discussionmentioning

confidence: 99%

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

2019

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Background: In-hospital mortality for patients presenting with acute pulmonary embolism (PE) has been reported to be up to 7 times higher for patients with decreased estimated glomerular filtration rate (eGFR). However, few studies have assessed its effect on long-term mortality. Objective: To determine the impact of eGFR and creatinine clearance (CrCl) on long-term all-cause mortality following acute PE in association with other routine laboratory analyses and comorbidities. Patients/Methods: The prospective study enrolled 141 consecutive patients presenting with objectively confirmed acute PE. Demographic, clinical data, comorbidities, and laboratory values were recorded. CrCl and GFR were estimated using the Cockcroft-Gault, MDRD, and chronic kidney disease (CKD)-EPI equations. Patients were followed up at 90 days and 1 year after the event. Results: In univariate analyses, age, active cancer, PE severity index (PESI), CrCl and eGFR, D-dimer value, and high-density lipoprotein level were found to be significantly associated with mortality in 90 days and 1 year. Additionally, body mass index was significant in the 1-year follow-up. CrCl by Cockcroft-Gault (90-day: area under the curve [AUC] 0.763; 1-year: AUC 0.718) demonstrated higher discriminatory power for predicting mortality than eGFR by the MDRD (AUC 0.686; AUC 0.609) and CKD-EPI (AUC 0.697; AUC 0.630) equations. In multivariate analyses, active cancer, CrCl by Cockcroft-Gault (90-day: hazard ratio [HR] 0.948, 95% CI 0.919–0.979; 1-year: HR 0.967, 95% CI 0.943–0.991), eGFR by CKD-EPI (90-day: HR 0.948, 95% CI 0.915–0.983; 1-year: HR 0.971, 95% CI 0.945–0.998) were found to be independent predictors of mortality. eGFR by MDRD, D-dimer, and PESI value were significant prognostic factors for 90-day mortality. Conclusion: Decreased renal function is a prognostic factor for increased all-cause mortality 90 days and 1 year after acute PE.

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“…First, there were no data on albuminuria, an essential determinant of CKD which is associated with higher risk for TE events and stroke,4 or functional status, a critical component of overall health in the geriatric population. Second, the time in therapeutic range (TTR) for VKAs, the most commonly used anticoagulant in this study, was not known.…”

Section: Commentarymentioning

confidence: 99%

Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrial fibrillation

Massicotte‐Azarniouch

Sood²

2018

BMJ EBM

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Risk of Venous Thromboembolism in Patients by Albuminuria and Estimated GFR

Cited by 22 publications

References 31 publications

Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation

Graft Function, Albuminuria, and the Risk of Hemorrhage and Thrombosis After Kidney Transplantation

Glomerular Filtration Rate as a Prognostic Factor for Long-Term Mortality after Acute Pulmonary Embolism

Uncertainty surrounds anticoagulation risks and benefits in patients with chronic kidney disease with atrial fibrillation

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