估算肾小球滤过率（eGFR）和蛋白尿与静脉血栓栓塞的关联。
Association of eGFR and Albuminuria with Venous Thromboembolism.
作者信息
Zheng Zhong, Pandit Krutika, Chang Alex R, Shin Jung-Im, Charytan David M, Grams Morgan E, Surapaneni Aditya
机构信息
Nephrology Division, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
Division of Precision Medicine, Department of Medicine, New York University Grossman School of Medicine, New York, New York.
出版信息
Clin J Am Soc Nephrol. 2024 Mar 1;19(3):301-308. doi: 10.2215/CJN.0000000000000352. Epub 2023 Nov 16.
BACKGROUND
CKD has been implicated as a risk factor of venous thromboembolism, but the evidence is limited to relatively healthy populations. The objective of this study was to discern whether parameters of kidney function and damage are associated with the occurrence of venous thromboembolism after hospitalization.
METHODS
We conducted a retrospective study including 23,899 and 11,552 adult individuals hospitalized within Geisinger Health System and New York University (NYU) Langone Health from 2004 to 2019 and 2012 to 2022, respectively. A Poisson model was used to evaluate adjusted incidence rates of venous thromboembolism according to eGFR and albuminuria categories in each cohort. Cox proportional hazards models were used to analyze associations of eGFR and urinary albumin-to-creatinine ratio (UACR) with venous thromboembolism, and hazard ratios (HRs) were meta-analyzed across cohorts.
RESULTS
Both lower eGFR and higher UACR were associated with higher risks of venous thromboembolism. In the Geisinger cohort, the incidence of venous thromboembolism after hospital discharge ranged from 10.7 (95% confidence interval [CI], 9.2 to 12.6) events per 1000 person-years in individuals in G1A1 (eGFR >90 ml/min per 1.73 m 2 and UACR <30 mg/g) to 27.7 (95% CI, 20.6 to 37.2) events per 1000 person-years in individuals with G4-5A3 (eGFR <30 ml/min per 1.73 m 2 and UACR >300 mg/g). A similar pattern was observed in the NYU cohort. Meta-analyses of the two cohorts showed that every 10 ml/min per 1.73 m 2 reduction in eGFR below 60 ml/min per 1.73 m 2 was associated with a 6% higher risk of venous thromboembolism (HR 1.06 [95% CI, 1.02 to 1.11], P = 0.01), and each two-fold higher UACR was associated with a 5% higher risk of venous thromboembolism (HR 1.05 [95% CI, 1.03 to 1.07], P < 0.001).
CONCLUSIONS
Both eGFR and UACR were independently associated with higher risk of venous thromboembolism after hospitalization. The incidence rate was higher with greater severity of CKD.
PODCAST
This article contains a podcast at https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_12_14_CJN0000000000000352.mp3.
背景
慢性肾脏病（CKD）已被认为是静脉血栓栓塞的一个风险因素，但证据仅限于相对健康的人群。本研究的目的是确定肾功能和损伤参数是否与住院后静脉血栓栓塞的发生有关。
方法
我们进行了一项回顾性研究，分别纳入了2004年至2019年在盖辛格医疗系统以及2012年至2022年在纽约大学朗格尼健康中心住院的23899名和11552名成年个体。采用泊松模型根据每个队列中的估算肾小球滤过率（eGFR）和蛋白尿类别评估静脉血栓栓塞的校正发病率。使用Cox比例风险模型分析eGFR和尿白蛋白与肌酐比值（UACR）与静脉血栓栓塞的关联，并对各队列的风险比（HR）进行荟萃分析。
结果
较低的eGFR和较高的UACR均与静脉血栓栓塞的较高风险相关。在盖辛格队列中，出院后静脉血栓栓塞的发生率在G1A1组（eGFR>90 ml/min per 1.73 m²且UACR<30 mg/g）的个体中为每1000人年10.7例（95%置信区间[CI]，9.2至12.6），在G4-5A3组（eGFR<30 ml/min per 1.73 m²且UACR>300 mg/g）的个体中为每1000人年27.7例（CI，20.6至37.2）。在纽约大学队列中观察到类似模式。两个队列的荟萃分析表明，eGFR低于60 ml/min per 1.73 m²每降低10 ml/min per 1.73 m²，静脉血栓栓塞风险增加6%（HR 1.06 [95% CI，1.02至1.11]，P = 0.01），UACR每升高两倍，静脉血栓栓塞风险增加5%（HR 1.05 [95% CI，1.03至1.07]，P < 0.001）。
结论
eGFR和UACR均与住院后静脉血栓栓塞的较高风险独立相关。CKD严重程度越高，发病率越高。
播客
本文包含一个播客，链接为https://dts.podtrac.com/redirect.mp3/www.asn-online.org/media/podcast/CJASN/2023_12_14_CJN0000000000000352.mp3 。
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