Renal dysfunction and long-term clinical outcomes in patients with venous thromboembolism: From the COMMAND VTE Registry. Issue 187 (March 2020)

• Record Type: Journal Article
• Authors: Tsuyuki, Yoshiaki; Yamashita, Yugo; Morimoto, Takeshi; Amano, Hidewo; Takase, Toru; Hiramori, Seiichi; Kim, Kitae; Oi, Maki; Kobayashi, Yohei; Ono, Koh; Aoyama, Takeshi; Kimura, Takeshi
• Is Part Of: Thrombosis research. Issue 187(2020)
• Page Start: 39
• Page End: 47
• Publication Date: 2020-03
• Subjects: Venous thromboembolism -- Renal dysfunction -- Bleeding -- Recurrence; Thrombosis -- Periodicals; 616.135
• DOI: 10.1016/j.thromres.2020.01.005
• Languages: English
• ISSNs: 0049-3848

Abstract

Abstract: Introduction: Patients with renal dysfunction are at high risk for developing venous thromboembolism (VTE). However, the impact of renal dysfunction on recurrent VTE remains to be clarified. We assessed the relationship between estimated glomerular filtration rate (eGFR) at diagnosis and long-term clinical outcomes in VTE patients. Materials and methods: The COMMAND VTE Registry is a multicenter registry enrolling consecutive patients with acute symptomatic VTE among 29 centers in Japan between January 2010 and August 2014. Patients with available creatinine values ( N = 2829) were divided into the reference eGFR (≥60 mL/min/1.73 m 2 ) group ( N = 1760) and the low eGFR (<60 mL/min/1.73 m 2 ) group ( N = 1069). The low eGFR group was further subdivided into the moderately low eGFR (30–59 mL/min/1.73 m 2 ) group ( N = 898) and very low eGFR (<30 mL/min/1.73 m 2 ) group ( N = 171). Results: The low eGFR group was independently associated with the increased risk for recurrent VTE (adjusted HR 1.55, 95%CI 1.15–2.08). When the low eGFR group was subdivided into the moderately low and very low eGFR groups, the risk for recurrent VTE increased with decreasing eGFR (adjusted HR 1.43, 95%CI 1.04–1.95, and adjusted HR 2.54, 95%CI 1.42–4.28). The risk for major bleeding was higher in the very low eGFR group, but not in the moderately low eGFR group (adjusted HR 1.70, 95%CI 1.06–2.61, and adjusted HR 0.85, 95%CI 0.73–1.28). Conclusions: Renal dysfunction measured by eGFR was associated with an increased risk for recurrent VTE, which was more prominent in severe renal dysfunction. Severe renal dysfunction was also associated with a higher risk for major bleeding. Highlights: Decreased eGFR was associated with the increased risk for recurrent VTE. Magnitude of risk for recurrent VTE was incrementally higher with decreasing eGFR. Patients with very low eGFR were also at higher risk of bleeding.