5 years ago

Chronic kidney disease and bleeding risk in patients at high cardiovascular risk: a cohort study

P.A. Doevendans, A. Algra, F.L. Visseren, M.C. Verhaar, G.J. de Borst, G. Ocak, M.B. Rookmaaker, , L.J. Kappelle
Background There are indications that patients with chronic kidney disease have an increased bleeding risk. Objectives The aim of our study was to investigate the association between chronic kidney disease and bleeding in patients at high cardiovascular risk. Methods We included 10,347 subjects referred to the University Medical Center Utrecht (the Netherlands) from September 1996 to February 2015 for an out-patient visit with classical risk factors for arterial disease or with symptomatic arterial disease (Second Manifestation of Arterial disease (SMART) cohort). Patients were staged according to the KDIGO guidelines, on the basis of estimated glomerular filtration rate (eGFR) and albuminuria, and were followed for the occurrence of major hemorrhagic events until March 2015. Hazard ratios (HRs) with 95% confidence intervals (CIs) for bleeding were calculated with Cox proportional hazards analyses. Results The incidence rate for bleeding in subjects with chronic kidney disease was 8.0 per 1,000 person-years and that for subjects without chronic kidney disease 3.5 per 1,000 person-years. Patients with chronic kidney disease (n=2,443) had a 1.5-fold (95%CI 1.2-1.9) increased risk of bleeding as compared with subjects without chronic kidney disease (n=7,904) after adjustment. Subjects with an eGFR <45 ml/min/1.73m2 with albuminuria had a 3.5-fold (95%CI 2.3-5.3) increased bleeding risk, while an eGFR <45 ml/min/1.73m2 without albuminuria was not associated with an increased bleeding risk (HR 1.3, 95%CI 0.7-2.5). Conclusion Chronic kidney disease is a risk factor for bleeding in patients with classical risk factors for arterial disease or with symptomatic arterial disease, especially in the presence of albuminuria. This article is protected by copyright. All rights reserved.

Publisher URL: http://onlinelibrary.wiley.com/resolve/doi

DOI: 10.1111/jth.13904

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