Measures of kidney function may be linked to thrombosis

Sep 18 2012

By Piriya Mahendra, medwireNews Reporter

Estimated glomerular filtration rate (eGFR) and albumin-creatinine ratio (ACR) are independently associated with venous thromboembolism (VTE), research suggests.

The findings, published in Circulation, show that in a study involving 95,514 participants, individuals with an eGFR of 75 ml/min per 1.73 m² had a 29% higher risk for VTE than those with an eGFR of 100 ml/min per 1.73 m².

This heightened risk worsened as eGFR levels fell, with a 31% increased risk for VTE among those with an eGFR of 60 ml/min per 1.73 m², an 82% increased risk for those with an eGFR of 45 ml/min per 1.73 m², and a 95% increased risk for those with an eGFR of 30 ml/min per 1.73 m².

The study also demonstrated that compared with individuals who had an ACR of 5.0 mg/g, those with an ACR of 30 mg/g were at a 34% higher risk for VTE, those with an ACR of 300 mg/g were at a 60% higher risk, and those with an ACR of 1000 mg/g at a 92% higher risk.

Ron Gansevoort (University Medical Centre Groningen, the Netherlands) and team note that there was no significant interaction between clinical categories of eGFR and ACR.

Adjusted analysis revealed that individuals diagnosed with chronic kidney disease (CKD; defined as eGFR <60 ml/min/1.73 m² or albuminuria ≥30 mg/g) had a significant 54% higher risk for VTE than those without CKD.

"CKD was similarly associated with provoked and unprovoked VTE and with pulmonary embolism and deep-vein thrombosis," the researchers add.

The effect of CKD on VTE incidence was consistent across all subgroups tested including gender, age, body mass index (BMI), and hypertension. However, there was a trend toward individuals with a BMI of 25 kg/m² or more exhibiting a weaker association between CKD and VTE than those with a BMI of less than 25 kg/m².

The study pooled participant data from five community-based cohorts in Europe and the USA. Over a 599,453 patient-years of follow up, 1178 VTE events occurred.

"CKD is associated with a broad range of diseases requiring hospitalization," comment the researchers. "This may have resulted in the association between CKD and provoked VTE.

"However, the association of eGFR and albuminuria with unprovoked VTE gives credence to a direct association of CKD with VTE."

The authors say that studies evaluating the effect of albuminuria-lowering drugs on the risk for VTE in patients with mild-to-moderate CKD are now warranted.

"Further, because VTE is common, based on the current findings it would be useful to assess whether CKD might be associated with the risk for recurrent VTE," they conclude.

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