轻度至中度慢性肾脏病与静脉血栓栓塞症的关联：五项前瞻性普通人群队列的汇总分析。
Association of mild to moderate chronic kidney disease with venous thromboembolism: pooled analysis of five prospective general population cohorts.
机构信息
Department of Nephrology, University Medical Center Groningen, University of Groningen, Groningen, The Netherlands.
出版信息
Circulation. 2012 Oct 16;126(16):1964-71. doi: 10.1161/CIRCULATIONAHA.112.113944. Epub 2012 Sep 13.
BACKGROUND
Recent findings suggest that chronic kidney disease (CKD) may be associated with an increased risk of venous thromboembolism (VTE). Given the high prevalence of mild-to-moderate CKD in the general population, in depth analysis of this association is warranted.
METHODS AND RESULTS
We pooled individual participant data from 5 community-based cohorts from Europe (second Nord-Trøndelag Health Study [HUNT2], Prevention of Renal and Vascular End-stage Disease [PREVEND], and the Tromsø study) and the United States (Atherosclerosis Risks in Communities [ARIC] and Cardiovascular Health Study [CHS]) to assess the association of estimated glomerular filtration rate (eGFR), albuminuria, and CKD with objectively verified VTE. To estimate adjusted hazard ratios for VTE, categorical and continuous spline models were fit by using Cox regression with shared-frailty or random-effect meta-analysis. A total of 1178 VTE events occurred over 599 453 person-years follow-up. Relative to eGFR 100 mL/min per 1.73 m(2), hazard ratios for VTE were 1.29 (95% confidence interval, 1.04-1.59) for eGFR 75, 1.31 (1.00-1.71) for eGFR 60, 1.82 (1.27-2.60) for eGFR 45, and 1.95 (1.26-3.01) for eGFR 30 mL/min per 1.73 m(2). In comparison with an albumin-to-creatinine ratio (ACR) of 5.0 mg/g, the hazard ratios for VTE were 1.34 (1.04-1.72) for ACR 30 mg/g, 1.60 (1.08-2.36) for ACR 300 mg/g, and 1.92 (1.19-3.09) for ACR 1000 mg/g. There was no interaction between clinical categories of eGFR and ACR (P=0.20). The adjusted hazard ratio for CKD, defined as eGFR <60 mL/min per 1.73 m(2) or albuminuria ≥30 mg/g, (versus no CKD) was 1.54 (95% confidence interval, 1.15-2.06). Associations were consistent in subgroups according to age, sex, and comorbidities, and for unprovoked versus provoked VTE, as well.
CONCLUSIONS
Both eGFR and ACR are independently associated with increased risk of VTE in the general population, even across the normal eGFR and ACR ranges.
背景
最近的研究结果表明，慢性肾脏病（CKD）可能与静脉血栓栓塞（VTE）的风险增加有关。鉴于轻度至中度 CKD 在普通人群中的高患病率，深入分析这种关联是必要的。
方法和结果
我们从欧洲的 5 个基于社区的队列（第二次诺德特兰健康研究[HUNT2]、预防肾脏和血管终末期疾病[PREVEND]和特罗姆瑟研究）和美国（社区动脉粥样硬化风险[ARIC]和心血管健康研究[CHS]）中汇总了个体参与者的数据，以评估估计肾小球滤过率（eGFR）、白蛋白尿和 CKD 与客观证实的 VTE 之间的关联。为了估计 VTE 的调整后的危险比，使用 Cox 回归和共享脆弱性或随机效应荟萃分析拟合分类和连续样条模型。在 599453 人年的随访中，共发生了 1178 例 VTE 事件。与 eGFR 100 mL/min per 1.73 m(2)相比，eGFR 75、eGFR 60、eGFR 45 和 eGFR 30 mL/min per 1.73 m(2)的 VTE 危险比分别为 1.29（95%置信区间，1.04-1.59）、1.31（1.00-1.71）、1.82（1.27-2.60）和 1.95（1.26-3.01）。与白蛋白与肌酐比值（ACR）为 5.0 mg/g 相比，ACR 为 30 mg/g、ACR 为 300 mg/g 和 ACR 为 1000 mg/g 的 VTE 危险比分别为 1.34（1.04-1.72）、1.60（1.08-2.36）和 1.92（1.19-3.09）。eGFR 和 ACR 的临床类别之间没有交互作用（P=0.20）。与无 CKD 相比，定义为 eGFR <60 mL/min per 1.73 m(2)或白蛋白尿≥30 mg/g 的 CKD 的调整后危险比为 1.54（95%置信区间，1.15-2.06）。在根据年龄、性别和合并症以及无诱因与诱因 VTE 进行的亚组分析中，相关性一致。
结论
即使在正常 eGFR 和 ACR 范围内，eGFR 和 ACR 均与普通人群中 VTE 风险增加独立相关。
Zotero 插件