Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

Katharine L. Cheung; Neil A. Zakai; Aaron R. Folsom; Manjula Kurella Tamura; Carmen A. Peralta; Suzanne E. Judd; Peter W. Callas; Mary Cushman

doi:10.1053/j.ajkd.2016.10.039

Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

Katharine L. Cheung, Neil A. Zakai, Aaron R. Folsom, Manjula Kurella Tamura, Carmen A. Peralta, Suzanne E. Judd, Peter W. Callas, Mary Cushman

Epidemiology

Research output: Contribution to journal › Article › peer-review

30 Scopus citations

Abstract

Background Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks. Study Design 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. Predictors Estimated glomerular filtration rate (eGFR) using the combined creatinine–cystatin C (eGFR_cr-cys) equation and urinary albumin-creatinine ratio (ACR). Outcomes The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event. Results 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_cr-cys of 60 to <90, 45 to <60, and <45 versus ≥90 mL/min/1.73 m² 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 <10 mg/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. Limitations Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power. Conclusions There was an independent association of low eGFR (<45 vs ≥90 mL/min/1.73 m²) with VTE risk, but no association of ACR and VTE.

Original language	English (US)
Pages (from-to)	182-190
Number of pages	9
Journal	American Journal of Kidney Diseases
Volume	70
Issue number	2
DOIs	https://doi.org/10.1053/j.ajkd.2016.10.039
State	Published - Aug 2017

Bibliographical note

Funding Information:
Support: This study was supported by cooperative agreement U01 NS041588 (G. Howard, Principal Investigator) from the National Institute of Neurological Disorders and Stroke (NINDS) and additional funding from American Recovery and Reinvestment Act grant RC1HL099460 (N. Zakai, Principal Investigator) from the National Heart, Lung, and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS; the NHLBI; or the National Institutes of Health. Representatives of the funding agency were not directly involved in the collection, management, analysis, or interpretation of the data. An unrestricted educational grant from Amgen Corp funded cystatin C and ACR measurements. The funders had no role in the study design, collection, analysis, or interpretation; writing the report, or the decision to submit the report for publication.

Publisher Copyright:
© 2017 National Kidney Foundation, Inc.

Keywords

Chronic kidney disease (CKD)
albumin-creatinine ratio (ACR)
albuminuria
deep vein thrombosis and pulmonary embolus
glomerular filtration rate (GFR)
kidney disease measures
race
renal insufficiency
vascular disease
venous thromboembolism (VTE)

UN SDGs

This output contributes to the following UN Sustainable Development Goals (SDGs)

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Cheung, K. L., Zakai, N. A., Folsom, A. R., Kurella Tamura, M., Peralta, C. A., Judd, S. E., Callas, P. W., & Cushman, M. (2017). Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. American Journal of Kidney Diseases, 70(2), 182-190. https://doi.org/10.1053/j.ajkd.2016.10.039

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title = "Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study",

abstract = "Background Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks. Study Design 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. Predictors Estimated glomerular filtration rate (eGFR) using the combined creatinine–cystatin C (eGFRcr-cys) equation and urinary albumin-creatinine ratio (ACR). Outcomes The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event. Results 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 eGFRcr-cys of 60 to <90, 45 to <60, and <45 versus ≥90 mL/min/1.73 m2 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 <10 mg/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. Limitations Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power. Conclusions There was an independent association of low eGFR (<45 vs ≥90 mL/min/1.73 m2) with VTE risk, but no association of ACR and VTE.",

keywords = "Chronic kidney disease (CKD), albumin-creatinine ratio (ACR), albuminuria, deep vein thrombosis and pulmonary embolus, glomerular filtration rate (GFR), kidney disease measures, race, renal insufficiency, vascular disease, venous thromboembolism (VTE)",

author = "Cheung, {Katharine L.} and Zakai, {Neil A.} and Folsom, {Aaron R.} and {Kurella Tamura}, Manjula and Peralta, {Carmen A.} and Judd, {Suzanne E.} and Callas, {Peter W.} and Mary Cushman",

note = "Funding Information: Support: This study was supported by cooperative agreement U01 NS041588 (G. Howard, Principal Investigator) from the National Institute of Neurological Disorders and Stroke (NINDS) and additional funding from American Recovery and Reinvestment Act grant RC1HL099460 (N. Zakai, Principal Investigator) from the National Heart, Lung, and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS; the NHLBI; or the National Institutes of Health. Representatives of the funding agency were not directly involved in the collection, management, analysis, or interpretation of the data. An unrestricted educational grant from Amgen Corp funded cystatin C and ACR measurements. The funders had no role in the study design, collection, analysis, or interpretation; writing the report, or the decision to submit the report for publication. Publisher Copyright: {\textcopyright} 2017 National Kidney Foundation, Inc.",

year = "2017",

month = aug,

doi = "10.1053/j.ajkd.2016.10.039",

language = "English (US)",

volume = "70",

pages = "182--190",

journal = "American Journal of Kidney Diseases",

issn = "0272-6386",

publisher = "W.B. Saunders Ltd",

number = "2",

}

TY - JOUR

T1 - Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

AU - Cheung, Katharine L.

AU - Zakai, Neil A.

AU - Folsom, Aaron R.

AU - Kurella Tamura, Manjula

AU - Peralta, Carmen A.

AU - Judd, Suzanne E.

AU - Callas, Peter W.

AU - Cushman, Mary

N1 - Funding Information: Support: This study was supported by cooperative agreement U01 NS041588 (G. Howard, Principal Investigator) from the National Institute of Neurological Disorders and Stroke (NINDS) and additional funding from American Recovery and Reinvestment Act grant RC1HL099460 (N. Zakai, Principal Investigator) from the National Heart, Lung, and Blood Institute (NHLBI). The content is solely the responsibility of the authors and does not necessarily represent the official views of the NINDS; the NHLBI; or the National Institutes of Health. Representatives of the funding agency were not directly involved in the collection, management, analysis, or interpretation of the data. An unrestricted educational grant from Amgen Corp funded cystatin C and ACR measurements. The funders had no role in the study design, collection, analysis, or interpretation; writing the report, or the decision to submit the report for publication. Publisher Copyright: © 2017 National Kidney Foundation, Inc.

PY - 2017/8

Y1 - 2017/8

N2 - Background Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks. Study Design 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. Predictors Estimated glomerular filtration rate (eGFR) using the combined creatinine–cystatin C (eGFRcr-cys) equation and urinary albumin-creatinine ratio (ACR). Outcomes The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event. Results 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 eGFRcr-cys of 60 to <90, 45 to <60, and <45 versus ≥90 mL/min/1.73 m2 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 <10 mg/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. Limitations Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power. Conclusions There was an independent association of low eGFR (<45 vs ≥90 mL/min/1.73 m2) with VTE risk, but no association of ACR and VTE.

AB - Background Kidney disease has been associated with venous thromboembolism (VTE) risk, but results conflict and there is little information regarding blacks. Study Design 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. Predictors Estimated glomerular filtration rate (eGFR) using the combined creatinine–cystatin C (eGFRcr-cys) equation and urinary albumin-creatinine ratio (ACR). Outcomes The primary outcome was adjudicated VTE, and secondary outcomes were provoked and unprovoked VTE, separately. Mortality was a competing-risk event. Results 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 eGFRcr-cys of 60 to <90, 45 to <60, and <45 versus ≥90 mL/min/1.73 m2 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 <10 mg/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. Limitations Single measurement of eGFR and ACR may have led to misclassification. Smaller numbers of events may have limited power. Conclusions There was an independent association of low eGFR (<45 vs ≥90 mL/min/1.73 m2) with VTE risk, but no association of ACR and VTE.

KW - Chronic kidney disease (CKD)

KW - albumin-creatinine ratio (ACR)

KW - albuminuria

KW - deep vein thrombosis and pulmonary embolus

KW - glomerular filtration rate (GFR)

KW - kidney disease measures

KW - race

KW - renal insufficiency

KW - vascular disease

KW - venous thromboembolism (VTE)

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JO - American Journal of Kidney Diseases

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Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study

Abstract

Bibliographical note

Keywords

UN SDGs

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