The Risk of Major Hemorrhage with CKD

Abstract

New staging systems for CKD account for both reduced eGFR and albuminuria; whether each measure associates with greater risk of hemorrhage is unclear. In this retrospective cohort study (2002-2010), we grouped 516,197 adults ≥40 years old by eGFR (≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, or <15 ml/min per 1.73 m(2)) and urine albumin-to-creatinine ratio (ACR; >300, 30-300, or <30 mg/g) to examine incidence of hemorrhage. The 3-year cumulative incidence of hemorrhage increased 20-fold across declining eGFR and increasing urine ACR groupings (highest eGFR/lowest ACR: 0.5%; lowest eGFR/highest ACR: 10.1%). Urine ACR altered the association of eGFR with hemorrhage (P<0.001). In adjusted models using the highest eGFR/lowest ACR grouping as the referent, patients with eGFR=15 to <30 ml/min per 1.73 m(2) had adjusted relative risks of hemorrhage of 1.9 (95% confidence interval [95% CI], 1.5 to 2.4) with the lowest ACR and 3.7 (95% CI, 3.0 to 4.5) with the highest ACR. Patients with the highest eGFR/highest ACR had an adjusted relative risk of hemorrhage of 2.3 (95% CI, 1.8 to 2.9), comparable with the risk for patients with the lowest eGFR/lowest ACR. The associations attenuated but remained significant after adjustment for anticoagulant and antiplatelet use in patients ≥66 years old. The risk of hemorrhage differed by urine ACR in high risk subgroups. Our data show that declining eGFR and increasing albuminuria each independently increase hemorrhage risk. Strategies to reduce hemorrhage events among patients with CKD are warranted.

Predicting in a predicament: Stroke and hemorrhage risk prediction in dialysis patients with atrial fibrillation

“…As previously described, hemorrhage risk scores in patients with atrial fibrillation include kidney dysfunction as a dichotomous risk factor, whereby dialysis patients are treated the same as patients with less severe kidney dysfunction. This would result in a considerable underestimate of hemorrhage risk when applied to dialysis patients, as this risk increases in an exponential fashion with declining eGFR …”

Gastrointestinal bleeding risk of selective serotonin reuptake inhibitors by level of kidney function: A population‐based cohort study

“…Chronic kidney disease (CKD) is a common condition in the community , and is independently associated with increased risk of bleeding in operative and nonoperative settings . Gastrointestinal (GI) bleeding is the most common manifestation of bleeding .…”

Impact of chronic kidney disease on long‐term clinical outcomes of everolimus‐eluting stent implantation: A subanalysis of the Tokyo‐MD PCI registry

“…Patients with CKD showed increased rates of CD (6.5% vs. 2.9%, P = 0.007), MACEs (26.9% vs. 14.0%, P < 0.001), stroke (5.2% vs. 2.8%, P = 0.04), and major bleeding (7.0% vs. 2.9%, P = 0.001) compared to those without CKD during follow‐up (Table ; Figures B,E and A,B). The mechanism underlying the relationship between renal function and adverse events is not clearly understood, but patients with CKD have comorbidities of cardiovascular risk factors and major bleeding . The effect of CKD on lipids and increased calcification may contribute to neoatherosclerosis and cardiovascular mortality .…”

“…The mechanism underlying the relationship between renal function and adverse events is not clearly understood, but patients with CKD have comorbidities of cardiovascular risk factors and major bleeding. [26][27][28][29] The effect of CKD on lipids and increased calcification may contribute to neoatherosclerosis and cardiovascular mortality. 30,31 Kurihara et al showed that TLR at 2-4 years was predicted by patient characteristics, which could be interpreted as factors strongly related to neoatherosclerosis.…”