Chest. 2020 Oct 5:S0012-3692(20)34850-9. doi: 10.1016/j.chest.2020.09.257. Online ahead of print.
BACKGROUND: Kidney disease has been linked to risk for hospitalization related venous thromboembolism (HR-VTE), but the effect size and differences across types of kidney disease are poorly described.
RESEARCH QUESTION: We sought to quantify the risk for HR-VTE among patients with acute kidney injury (AKI) and chronic kidney disease (CKD).
STUDY DESIGN AND METHODS: We prospectively collected data on hospitalized adult patients and documented HR-VTE events. We recorded creatinine clearance (CrCl) daily throughout hospitalization, and modeled the effects that admission CrCl, peak CrCl, average CrCl, and AKI have on HR-VTE. We controlled for known VTE risk factors and daily administration of chemoprophylaxis.
RESULTS: Of the 6,552 admissions that met our inclusion criteria, there were 184 (2.81%) patients with a HR-VTE. Surgery, AKI, chemical prophylaxis, and admission albumin were all associated with HR-VTE in univariate analysis, but neither admission CrCl nor average CrCl (throughout the hospitalization) increased the odds of HR-VTE. Kaplan-Meier curves showed AKI, whether it occurred before or during the hospitalization, was significantly associated with time to HR-VTE. Cox-regression analysis found AKI was independently associated with HR-VTE, as was surgery during admission, enoxaparin dose, , and admission albumin. Sensitivity analyses showed AKI lost significance when only patients with traumatic injuries were assessed.
INTERPRETATION: We found AKI increases the risk for HR-VTE in a large, heterogeneous population that includes medical and surgical patients. However, this relationship was not seen in patients with traumatic injuries.