Mahady Suzanne E, Polekhina Galina, Woods Robyn L, Wolfe Rory, Wetmore James B, Margolis Karen L, Wood Erica M, Cloud Geoffrey C, Murray Anne M, Polkinghorne Kevan R
School of Public Health and Preventive Medicine, Monash University, Melbourne, Victoria, Australia.
Department of Gastroenterology, Melbourne Health, Parkville, Victoria, Australia.
Kidney Int Rep. 2023 Jan 19;8(4):737-745. doi: 10.1016/j.ekir.2023.01.012. eCollection 2023 Apr.
Data on the association between chronic kidney disease (CKD) and major hemorrhage in older adults are lacking.
We used data from a double-blind randomized controlled trial of aspirin in persons aged ≥ 70 years with prospective capture of bleeding events, including hemorrhagic stroke and clinically significant bleeding. CKD was defined as an estimated glomerular filtration rate (eGFR) < 60 ml/min per 1.73 m and/or urinary albumin-to-creatinine ratio (UACR) ≥ 3 mg/mmol (26.6 mg/g). We compared bleeding rates in those with and without CKD, undertook multivariable analyses, and explored effect modification with aspirin.
Of 19,114 participants, 17,976 (94.0%) had CKD status recorded, of whom 4952 (27.5%) had CKD. Participants with CKD had an increased rate of major bleeding events compared with those without CKD (10.4/1000 vs. 6.3/1000 person-years [py], respectively) and increased bleeding risk (risk ratio [RR] 1.60; 95% confidence interval [CI]: 1.40, 1.90 for eGFR < 60 ml/min per 1.73 m) and RR (2.10; 95% CI: 1.70, 2.50) for albuminuria. In adjusted analyses, CKD was associated with a 35% increased risk of bleeding (hazard ratio [HR] 1.37; 95% CI: 1.15, 1.62; < 0.001). Other risk factors were older age, hypertension, smoking, and aspirin use. There was no differential effect of aspirin on bleeding by CKD status (test of interaction = 0.65).
CKD is independently associated with an increased risk of major hemorrhage in older adults. Increased awareness of modifiable risk factors such as discontinuation of unnecessary aspirin, blood pressure control, and smoking cessation in this group is warranted.
缺乏关于老年慢性肾脏病（CKD）与大出血之间关联的数据。
我们使用了一项针对年龄≥70岁人群的阿司匹林双盲随机对照试验的数据，前瞻性记录出血事件，包括出血性中风和具有临床意义的出血。CKD定义为估计肾小球滤过率（eGFR）<60 ml/（min·1.73 m²）和/或尿白蛋白与肌酐比值（UACR）≥3 mg/mmol（26.6 mg/g）。我们比较了有和没有CKD者的出血率，进行多变量分析，并探讨阿司匹林的效应修正作用。
在19114名参与者中，17976名（94.0%）记录了CKD状态，其中4952名（27.5%）患有CKD。与没有CKD者相比，患有CKD的参与者大出血事件发生率更高（分别为10.4/1000人年和6.3/1000人年），出血风险增加（风险比[RR]1.60；eGFR<60 ml/（min·1.73 m²）时95%置信区间[CI]：1.40，1.90），蛋白尿的RR为（2.10；95%CI：1.70，2.50）。在调整分析中，CKD与出血风险增加35%相关（风险比[HR]1.37；95%CI：1.15，1.62；P<0.001）。其他风险因素包括年龄较大、高血压、吸烟和使用阿司匹林。阿司匹林对出血的影响在有无CKD状态之间没有差异（交互作用检验P=0.65）。
CKD与老年人大出血风险增加独立相关。有必要提高对该人群中可改变风险因素的认识，如停用不必要的阿司匹林、控制血压和戒烟。
