Risk of venous thrombosis in patients with chronic kidney disease: identification of high-risk groups

Authors

  • G. Ocak,

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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  • W. M. Lijfering,

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
    2. Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
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  • M. Verduijn,

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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  • F. W. Dekker,

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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  • F. R. Rosendaal,

    Corresponding author
    1. Department of Thrombosis and Haemostasis, Leiden University Medical Center, Leiden, The Netherlands
    • Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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  • S. C. Cannegieter,

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
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  • C. Y. Vossen

    1. Department of Clinical Epidemiology, Leiden University Medical Center, Leiden, The Netherlands
    2. Division of Biomedical Genetics, Department of Medical Genetics, University Medical Center Utrecht, Utrecht, the Netherlands
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Correspondence: Frits R. Rosendaal, Department of Clinical Epidemiology, Leiden University Medical Center, PO Box 9600, 2300 RC Leiden, the Netherlands.

Tel.: +31 71 526 4037; fax: +31 71 526 6994.

E-mail: f.r.rosendaal@lumc.nl

Summary

Background

Although an association between venous thrombosis and chronic kidney disease has recently been established, it is unknown which patients with chronic kidney disease are most likely to benefit from thromboprophylaxis.

Objective

The aim of this study was to assess the association between venous thrombosis and chronic kidney disease in combination with arterial thrombosis, malignancy, surgery and thrombophilia to identify high-risk groups as a basis for personalized prevention.

Methods

This study included 2473 consecutive patients with first venous thrombosis and 2936 controls from a case–control study (the MEGA study).

Results

Moderately decreased kidney function (eGFR 30–60 mL min−1) was associated with a 2.5-fold (95% CI, 1.9–3.4) increased risk and severely decreased kidney function (eGFR < 30 mL min−1) was associated with a 5.5-fold (95% CI 1.8–16.7) increased risk of venous thrombosis, compared with those with normal kidney function (eGFR > 90 mL min−1). The risk of venous thrombosis was additionally increased for moderately and severely reduced kidney function in combination with arterial thrombosis (odds ratio, 4.9; 95% CI, 2.2–10.9), malignancy (5.8; 95% CI, 2.8–12.1), surgery (14.0; 95%, CI 5.0–39.4), immobilization (17.1; 95% CI, 6.8–43.0) or thrombophilia (odds ratios, 4.3–9.5), with particularly high risks when three or more risk factors were present (odds ratio, 56.3; 95% CI, 7.6–419.3).

Conclusion

Decreased kidney function is associated with an increased risk of venous thrombosis. The risk increased substantially in the presence of one or more other risk factors for thrombosis.

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