Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study. Issue 151 (March 2017)

• Record Type: Journal Article
• Authors: Kuo, Tsung-Hang; Li, Hsin-Yang; Lin, Sheng-Hsiang
• Is Part Of: Thrombosis research. Issue 151(2017)
• Page Start: 29
• Page End: 35
• Publication Date: 2017-03
• Subjects: AKI acute kidney injury -- CKD chronic kidney disease -- DVT deep vein thrombosis -- PE pulmonary embolism -- VTE venous thromboembolism -- NHI national health insurance -- NHIRD the national health insurance research database -- ICD-9-CM international classification of diseases, 9th revision, clinical modification -- EC enrollee category -- CRR competing risk regression -- ESRD end stage renal disease -- COPD chronic obstructive pulmonary disease -- HR hazard ratio -- OR odds ratio -- CI confidence interval; Acute kidney injury -- Cohort study -- National health insurance -- Venous thromboembolism -- Deep vein thrombosis -- Pulmonary embolism; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2017.01.004
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Chronic kidney disease (CKD) increases risk for deep vein thrombosis (DVT) and pulmonary embolism (PE). However, few studies have investigated the relationship between acute kidney injury (AKI) and risk of DVT and PE. Therefore, we conducted a nationwide longitudinal cohort study to determine whether patients with AKI are associated with increased risk of developing DVT and PE. Methods: We included > 30 years-old inpatients (n = 4734) receiving the diagnosis of AKI from 2000 to 2006 and their age-and sex-matched non-AKI inpatients using medical service in the same year (n = 47.340). Diagnosis of DVT and PE was recorded within 5-year after the AKI event or index use of medical service. The hazard ratios were analyzed using Cox regression model and adjustments were made for demographic factors, selected comorbidities and treatments. A time-dependent covariate survival analysis was performed for variations of some comorbidities, treatments and hospitalization. Competing risk regression (CRR) model was also used to adjust the risk for death. Propensity score matching was used to minimize potential selection bias. We also performed sensitivity analysis to examine the effect of other possible residual confounding factors. Results: After adjusting for demographic characteristics, selected comorbidities and treatment, AKI remained a predisposing factor with a 1.44-fold (95% CI, 1.04–2.01) and 1.49-fold (95% CI, 1.12–1.97) increase in patients who were at a risk for developing DVT within 3 and 5 years. AKI also remained a significant predisposing factor with a 2.66-fold (95% CI, 1.49–3.20) increase in patients who were at a risk for developing PE within 3 years. However, there were no significant results for PE within 5 years. The hazard ratios of time-dependent covariate survival analysis and CRR model showed the similar results. Conclusions: Risk of DVT and PE is higher in patients with AKI than in the general population. Highlights: This is the first cohort study to use population-based data to determine whether AKI is an independent risk factor for VTE. The risks for DVT and PE were higher in the AKI group than in the non-AKI group. These findings emphasize the importance of early treatment for AKI to reduce the risk of VTE.