Cheung Katharine L, Zakai Neil A, Folsom Aaron R, Kurella Tamura Manjula, Peralta Carmen A, Judd Suzanne E, Callas Peter W, Cushman Mary
Larner College of Medicine, University of Vermont, Burlington, VT.
Larner College of Medicine, University of Vermont, Burlington, VT.
Am J Kidney Dis. 2017 Aug;70(2):182-190. doi: 10.1053/j.ajkd.2016.10.039. Epub 2017 Jan 23.
Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks.
Prospective cohort study.
SETTING & 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.
Estimated glomerular filtration rate (eGFR) using the combined creatinine-cystatin C (eGFR) equation and urinary albumin-creatinine ratio (ACR).
The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event.
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 eGFR of 60 to <90, 45 to <60, and <45 versus ≥90mL/min/1.73m 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.
Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power.
There was an independent association of low eGFR (<45 vs ≥90mL/min/1.73m) with VTE risk, but no association of ACR and VTE.
肾病与静脉血栓栓塞（VTE）风险相关，但结果存在冲突，且关于黑人的信息较少。
前瞻性队列研究。
2003年至2007年纳入REGARDS（中风地理和种族差异原因）研究的30239名45岁及以上的黑人和白人成年人。
使用肌酐-胱抑素C联合方程估算的肾小球滤过率（eGFR）和尿白蛋白-肌酐比值（ACR）。
主要结局为经判定的VTE，次要结局分别为诱因性和非诱因性VTE。死亡率是一个竞争风险事件。
在4.6年的随访期间，124624人年中发生了239例VTE事件。使用针对年龄、性别、种族、居住地区和体重指数进行调整的比例风险回归计算VTE的病因特异性风险比。eGFR为60至<90、45至<60和<45对比≥90mL/min/1.73m时，调整后的VTE风险比分别为1.28（95%CI，0.94 - 1.76）、1.30（95%CI，0.77 - 2.18）和2.13（95%CI，1.21 - 3.76）。ACR为10至<30、30至<300和≥300对比<10mg/g时，调整后的VTE风险比分别为1.14（95%CI，0.84 - 1.56）、1.15（95%CI，0.79 - 1.69）和0.64（95%CI，0.25 - 1.62）。诱因性和非诱因性VTE的关联相似。
eGFR和ACR的单次测量可能导致分类错误。事件数量较少可能限制了检验效能。
低eGFR（<45对比≥90mL/min/1.73m）与VTE风险存在独立关联，但ACR与VTE无关联。
