Department of Community Health, Warren Alpert Medical School, Brown University, Providence, RI, USA.
Am J Kidney Dis. 2011 Nov;58(5):746-55. doi: 10.1053/j.ajkd.2011.06.021. Epub 2011 Aug 27.
An increased frequency of venous thromboembolism (VTE) has been shown in patients with decreased kidney function measured by decreased estimated glomerular filtration rate (eGFR). However, present practices with respect to VTE prevention and management in patients with decreased eGFR in general population settings are uncertain.
Observational study.
SETTING & PARTICIPANTS: Community investigation of 1,509 metropolitan Worcester, MA, residents with a validated VTE in 1999, 2001, and 2003 with further follow-up for up to 3 years.
Patients with VTE classified further according to eGFR on presentation: <30, 30-59, 60-89, or ≥90 mL/min/1.73 m(2) (reference group).
Recurrent VTE, major bleeding episodes, and all-cause mortality.
Demographic and clinical characteristics, treatment practices, and study outcomes were extracted from patients' hospital and outpatient medical records; eGFR was estimated using the Chronic Kidney Disease Epidemiology Collaboration (CKD-EPI) equation.
Patients with VTE with eGFR <30 mL/min/1.73 m(2) were at increased risk of recurrent VTE (HR, 1.83; 95% CI, 1.03-3.25), major bleeding episodes (HR, 2.30; 95% CI, 1.28-4.16), and all-cause mortality (HR, 1.70; 95% CI, 1.12-2.57) during a 3-year follow-up. Patients with decreased eGFR also presented with more comorbid conditions and were less likely to be discharged on any form of anticoagulant therapy (72.6%, 81.0%, 82.1%, and 87.3% for eGFR <30, 30-59, 60-89, and ≥90 mL/min/1.73 m(2), respectively; P < 0.001).
Decreased eGFR status is presumed based on creatinine values on clinical presentation. The impact of drug dosage, timing, type of anticoagulant therapy, and medication adherence on study outcomes could not be evaluated.
Severe decreases in eGFR are associated with increased risk of long-term recurrent VTE, bleeding, and total mortality in patients with VTE. A greater frequency of serious comorbid conditions, difficulties implementing available management strategies, and suboptimal VTE prophylaxis during hospital admissions likely contributed to our findings.
已有研究表明，估算肾小球滤过率（eGFR）降低的患者发生静脉血栓栓塞症（VTE）的频率更高。然而，目前在一般人群中，对于 eGFR 降低患者的 VTE 预防和管理尚不确定。
观察性研究。
1999 年、2001 年和 2003 年，在马萨诸塞州伍斯特市的 1509 名大都市居民中进行了一项经验证的 VTE 社区调查，随后对他们进行了长达 3 年的随访。
根据 VTE 患者就诊时的 eGFR 进一步分类：<30、30-59、60-89 或 ≥90 mL/min/1.73 m²（参考组）。
复发性 VTE、大出血事件和全因死亡率。
从患者的住院和门诊病历中提取人口统计学和临床特征、治疗实践和研究结局；使用慢性肾脏病流行病学合作（CKD-EPI）方程估算 eGFR。
eGFR <30 mL/min/1.73 m²的 VTE 患者发生复发性 VTE（HR，1.83；95%CI，1.03-3.25）、大出血事件（HR，2.30；95%CI，1.28-4.16）和全因死亡率（HR，1.70；95%CI，1.12-2.57）的风险增加，在 3 年的随访期间。eGFR 降低的患者还伴有更多的合并症，出院时接受任何形式抗凝治疗的可能性较低（eGFR <30、30-59、60-89 和 ≥90 mL/min/1.73 m² 组分别为 72.6%、81.0%、82.1%和 87.3%；P<0.001）。
eGFR 状态是根据临床就诊时的肌酐值推测的。药物剂量、时机、抗凝治疗类型和药物依从性对研究结果的影响无法评估。
在 VTE 患者中，eGFR 严重降低与长期复发性 VTE、出血和总死亡率风险增加相关。更频繁的严重合并症、实施现有管理策略的困难以及住院期间预防 VTE 的效果不佳可能导致了我们的发现。
