VTE risk appears to progressively increase as eGFR decreases and albumin-creatinine ratio increases

Even mild kidney disease is associated with an increase in risk of venous thromboembolism (VTE), a new review found.

The pooled analysis of individual data included five prospective cohort studies of almost 100,000 people in Europe and the United States. A total of 1,178 VTEs occurred during the follow-up of about six years. Using Cox regression models, the researchers calculated that patients with decreased estimated glomerular filtration rate (eGFR) had a higher risk of VTE than patients with an eGFR of 100 mL/min/1.73m². The hazard ratio (HR) was 1.29 (95% CI, 1.04 to 1.59) for an eGFR of 75 mL/min/1.73m², 1.31 (95% CI, 1.00 to 1.71) for an eGFR of 60 mL/min/1.73m², 1.82 (95% CI, 1.27 to 2.60) for an eGFR of 45 mL/min/1.73m² and 1.95 (95% CI, 1.26 to 3.01) for an eGFR of 30 mL/min/1.73m².

A worse albumin-creatinine ratio (ACR) than 5.0 mg/g was also associated with higher risk of VTE: for 30 mg/g, the HR was 1.34 (95% CI, 1.04 to 1.72); for 300 mg/g, the HR was 1.60 (95% CI, 1.08 to 2.36); and for 1,000 mg/g, the HR was 1.92 (95% CI, 1.19 to 3.09). The associations of the two measurements with VTE were independent of each other and traditional cardiovascular risk factors, the researchers said. They concluded that mild changes in both eGFR and ACR are independently associated with more VTE, and that the risk increases progressively as eGFR declines and ACR increases. The study was published online by Circulation on Sept. 13.

The results clarify previous inconsistent findings on this question, the authors said, and support the existence of a direct association between chronic kidney disease and VTE. That association may result from endothelial injury or changes in procoagulant proteins, they suggested. Because these levels of chronic kidney disease are prevalent in the general population and are more modifiable with medication than most VTE risk factors, some VTEs might be prevented by attention to this relationship. Future studies should assess the impact of drugs that improve albuminuria on VTE, the authors said.