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Acute Kidney Injury During Hospitalization Increases the Risk of VTE

Published:October 04, 2020DOI:https://doi.org/10.1016/j.chest.2020.09.257

      Background

      Kidney disease has been linked to risk for hospitalization-related (HR) VTE, but the effect size and differences across types of kidney disease are described poorly.

      Research Question

      Can the risk for HR VTE among patients with acute kidney injury (AKI) and chronic kidney disease be quantified, and if so, how?

      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 had 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, 184 (2.81%) patients experienced an HR VTE. Surgery, AKI, chemical prophylaxis, and admission albumin all were 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 associated significantly with time to HR VTE. Cox regression analysis found that AKI was associated independently with HR VTE, as was surgery during admission, enoxaparin dose, and admission albumin. Sensitivity analyses showed that AKI lost significance when only patients with traumatic injuries were assessed.

      Interpretation

      We found that AKI increases the risk for HR VTE in a large, heterogeneous population that included medical and surgical patients. However, this relationship was not seen in patients with traumatic injuries.

      Key Words

      Abbreviations:

      AKI (acute kidney injury), CKD (chronic kidney disease), CrCl (creatinine clearance), HR (hospitalization-related), KDIGO (Kidney Disease: Improving Global Outcomes), LMWH (low-molecular-weight heparin), UFH (unfractionated heparin)
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