Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study

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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.

Original languageEnglish
Pages (from-to)29-35
Number of pages7
JournalThrombosis Research
Volume151
DOIs
Publication statusPublished - 2017 Mar 1

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Pulmonary Embolism
Taiwan
Acute Kidney Injury
Venous Thrombosis
Cohort Studies
Retrospective Studies
Comorbidity
Survival Analysis
Causality
Inpatients
Demography
Propensity Score
Selection Bias
Chronic Renal Insufficiency
Proportional Hazards Models
Longitudinal Studies
Hospitalization
Therapeutics
Kidney
Wounds and Injuries

All Science Journal Classification (ASJC) codes

  • Hematology

Cite this

@article{0d75bb49af8f44af9f79144ab5c07bd9,
title = "Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan: A nationwide retrospective cohort study",
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.",
author = "Tsung-Hang Kuo and Li, {Hsin Yang} and Sheng-Hsiang Lin",
year = "2017",
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doi = "10.1016/j.thromres.2017.01.004",
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T1 - Acute kidney injury and risk of deep vein thrombosis and pulmonary embolism in Taiwan

T2 - A nationwide retrospective cohort study

AU - Kuo, Tsung-Hang

AU - Li, Hsin Yang

AU - Lin, Sheng-Hsiang

PY - 2017/3/1

Y1 - 2017/3/1

N2 - 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.

AB - 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.

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U2 - 10.1016/j.thromres.2017.01.004

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