Risk of Venous Thromboembolism in Patients by Albuminuria and Estimated GFR

摘要

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? 90mL/min/1.73m 2 ) 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/1.73m 2 ), 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 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.