Chronic Kidney Disease Increases Risk for Venous Thromboembolism

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Conclusion: Patients with advanced chronic kidney disease (CKD) are at increased risk for incident venous thromboembolism (VTE). Summary: CKD is known to be associated with increased risk of morbidity and mortality from cardiovascular disease. This study sought to evaluate in a community-based population the risk of VTE in CKD patients who were not dependent on dialysis. The authors used data from the Longitudinal Investigation of Thromboembolism Etiology (LITE) study. This study used established cohorts from the Atherosclerosis Risk in Communities (ARIC) study and the Cardiovascular Health Study (CHS). Altogether, 19,073 middle-aged and elderly adults were categorized on the basis of estimated glomerular filtration rate (GFR) and cystatin C concentration. Cystatin C levels were only available in patients from the CHS study. The patients were divided into quartiles by estimated GFR and cystatin C. During a mean follow-up of 11.8 years, VTE developed in 413 participants. The relative risk of VTE in patients with mildly decreased renal function compared with those with normal renal function was 1.28 (95% confidence interval [CI], 1.02-1.59). For those with stage III or IV CKD, the relative risk for VTE was 2.09 (95% CI, 1.47-2.96). This was with adjustment for age, gender, race, and center. An increased risk of VTE was still observed in participants with stage III/IV CKD after further adjustment for cardiovascular disease risk factors (relative risk, 1.17; 95% CI, 1.18-2.49). There was no significant association between cystatin C and VTE. Comment: This is the first study demonstrating the association between mild to moderate decreased kidney function and VTE in the general population. It is important to remember that estimation of renal function in this study was based on a single measurement of serum creatinine that occurred at an average of 11.8 years before the incident VTE events. It is unclear whether changes in kidney function during this almost 12-year interval could have resulted in systematic misclassification of CKD status at the time of the VTE event. Therefore, the data should be regarded as suggestive, but not definitive, that patients with mild to moderate CKD are at increased risk for VTE.