The Risk of Major Hemorrhage with CKD

Journal of the American Society of Nephrology : JASN
Amber O MolnarManish M Sood

Abstract

New staging systems for CKD account for both reduced eGFR and albuminuria; whether each measure associates with greater risk of hemorrhage is unclear. In this retrospective cohort study (2002-2010), we grouped 516,197 adults ≥40 years old by eGFR (≥90, 60 to <90, 45 to <60, 30 to <45, 15 to <30, or <15 ml/min per 1.73 m(2)) and urine albumin-to-creatinine ratio (ACR; >300, 30-300, or <30 mg/g) to examine incidence of hemorrhage. The 3-year cumulative incidence of hemorrhage increased 20-fold across declining eGFR and increasing urine ACR groupings (highest eGFR/lowest ACR: 0.5%; lowest eGFR/highest ACR: 10.1%). Urine ACR altered the association of eGFR with hemorrhage (P<0.001). In adjusted models using the highest eGFR/lowest ACR grouping as the referent, patients with eGFR=15 to <30 ml/min per 1.73 m(2) had adjusted relative risks of hemorrhage of 1.9 (95% confidence interval [95% CI], 1.5 to 2.4) with the lowest ACR and 3.7 (95% CI, 3.0 to 4.5) with the highest ACR. Patients with the highest eGFR/highest ACR had an adjusted relative risk of hemorrhage of 2.3 (95% CI, 1.8 to 2.9), comparable with the risk for patients with the lowest eGFR/lowest ACR. The associations attenuated but remained significant after adjustment for an...Continue Reading

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Citations

Nov 1, 2016·Clinical Journal of the American Society of Nephrology : CJASN·Vaibhav Keskar, Manish M Sood
Feb 23, 2019·Current Opinion in Nephrology and Hypertension·Jeffrey T HaMin Jun
Dec 17, 2019·Journal of Oncology Pharmacy Practice : Official Publication of the International Society of Oncology Pharmacy Practitioners·Arianne DuongDavid Garcia
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Apr 24, 2019·Clinical Journal of the American Society of Nephrology : CJASN·Thomas A MavrakanasDavid M Charytan
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Jun 4, 2021·Stroke; a Journal of Cerebral Circulation·Dearbhla M KellyManish M Sood
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Jun 3, 2021·Journal of Cardiovascular Pharmacology·Murti PatelCory R Trankle

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