Department of Clinical Epidemiology, Leiden University Medical Centre, Leiden, The Netherlands.
J Thromb Haemost. 2010 Nov;8(11):2428-35. doi: 10.1111/j.1538-7836.2010.04048.x.
End-stage renal disease has been associated with venous thrombosis (VT). However, the risk of VT in the early stages of chronic kidney disease (CKD) has not yet been investigated. The aim of this study was to investigate whether CKD patients with stage 1-3 disease are at increased risk of VT.
Eight thousand four hundred and ninety-five subjects were included in a prospective cohort study, in which renal function and albuminuria were assessed, starting in 1997-1998, and were followed for the occurrence of VT until 1 June 2007. CKD patients were staged according to the Kidney Disease Outcomes Quality Initiative guidelines, on the basis of 24-h urine albumin excretion and estimated glomerular filtration rates. Objectively verified symptomatic VT was considered to be the endpoint.
Of the 8495 subjects, 243 had CKD stage 1, 856 CKD stage 2, and 491 CKD stage 3. During a median follow-up period of 9.2 years, 128 individuals developed VT. The hazard ratios (HRs) for CKD stages 1, 2 and 3 were, respectively, 2.2 [95% confidence interval (CI) 0.9-5.1], 1.9 (95% CI 1.1-3.1) and 1.6 (95% CI 0.9-2.8) relative to those without CKD after adjustment for age, sex, body mass index, hypertension, diabetes, malignancy, and high-sensitivity C-reactive protein. Subjects with CKD stage 3 and albuminuria (≥ 30 mg d(-1)) had an adjusted HR of 3.0, and subjects with CKD stage 3 without albuminuria had an adjusted HR of 1.0.
CKD stages 1 and 2, and CKD stage 3 in the presence of albuminuria, are risk factors for VT. The risk of VT is more related to albuminuria than to impaired glomerular filtration rate.
终末期肾病与静脉血栓形成（VT）有关。然而，慢性肾脏病（CKD）早期阶段发生 VT 的风险尚未得到研究。本研究旨在探讨 1-3 期 CKD 患者是否有更高的 VT 风险。
8495 例受试者纳入前瞻性队列研究，1997-1998 年开始评估肾功能和尿白蛋白排泄，随访至 2007 年 6 月 1 日，以发生 VT 为终点。根据 24 小时尿白蛋白排泄和估计肾小球滤过率，按照肾脏病预后质量倡议指南对 CKD 患者进行分期。经客观证实的有症状 VT 被视为终点。
8495 例受试者中，243 例患有 CKD 1 期，856 例患有 CKD 2 期，491 例患有 CKD 3 期。中位随访 9.2 年后，128 例发生 VT。CKD 1 期、2 期和 3 期的危险比（HRs）分别为 2.2（95%可信区间 0.9-5.1）、1.9（95%可信区间 1.1-3.1）和 1.6（95%可信区间 0.9-2.8），校正年龄、性别、体重指数、高血压、糖尿病、恶性肿瘤和高敏 C 反应蛋白后与无 CKD 者相比。合并 CKD 3 期和白蛋白尿（≥30mg/d）的受试者校正 HR 为 3.0，无白蛋白尿的 CKD 3 期受试者校正 HR 为 1.0。
CKD 1 期和 2 期以及存在白蛋白尿的 CKD 3 期是 VT 的危险因素。VT 的风险与白蛋白尿的关系更为密切，与肾小球滤过率的损害关系不大。
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