Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study.

Cheung KL, Zakai NA, Folsom AR, Kurella Tamura M, Peralta CA, Judd SE, Callas PW, Cushman M. Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. American journal of kidney diseases : the official journal of the National Kidney Foundation. 2017 Aug 1; 70(2):182-190.

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Abstract:

BACKGROUND: Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks. STUDY DESIGN: Prospective cohort study. SETTING and PARTICIPANTS: 30,239 black and white adults 45 years or older enrolled in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study 2003 to 2007. PREDICTORS: Estimated glomerular filtration rate (eGFR) using the combined creatinine-cystatin C (eGFRcr-cys) equation and urinary albumin-creatinine ratio (ACR). OUTCOMES: The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event. RESULTS: During 4.6 years of follow-up, 239 incident VTE events occurred over 124,624 person-years. Cause-specific HRs of VTE were calculated using proportional hazards regression adjusted for age, sex, race, region of residence, and body mass index. Adjusted VTE HRs for eGFRcr-cys of 60 to  < 90, 45 to  < 60, and  < 45 versus  = 90mL/min/1.73m(2) were 1.28 (95% CI, 0.94-1.76), 1.30 (95% CI, 0.77-2.18), and 2.13 (95% CI, 1.21-3.76). Adjusted VTE HRs for ACR of 10 to  < 30, 30 to  < 300, and  = 300 versus  < 10mg/g were 1.14 (95% CI, 0.84-1.56), 1.15 (95% CI, 0.79-1.69), and 0.64 (95% CI, 0.25-1.62). Associations were similar for provoked and unprovoked VTE. LIMITATIONS: Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power. CONCLUSIONS: There was an independent association of low eGFR ( < 45 vs  = 90mL/min/1.73m(2)) with VTE risk, but no association of ACR and VTE.