Risk factors for predicting venous thromboembolism in patients with nephrotic syndrome: focus on haemostasis-related parameters
Purpose The venous thromboembolic events (VTE) incidence is high in nephrotic syndrome (NS). We aimed to assess prospectively the risk of VTE in a large cohort of NS patients and to identify predictive factors for VTE, especially haemostasis-related parameters. Methods This is the prospective, obser...
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Veröffentlicht in: | International urology and nephrology 2014-04, Vol.46 (4), p.787-792 |
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Sprache: | eng |
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Zusammenfassung: | Purpose
The venous thromboembolic events (VTE) incidence is high in nephrotic syndrome (NS). We aimed to assess prospectively the risk of VTE in a large cohort of NS patients and to identify predictive factors for VTE, especially haemostasis-related parameters.
Methods
This is the prospective, observational study conducted in 256 adults with idiopathic NS. VTE were the study outcome. Clinical data, proteinuria, albuminuria, haemostasis and fibrinolysis parameters, and D-dimers were evaluated every 6 months.
Results
Median follow-up time was 24 [IQR 12–72] months. VTE cumulative and rate incidence were 11 % and 4.4 per 100 patient-years. Baseline higher proteinuria, lower serum albumin, low antithrombin III activity, and, surprisingly, high ionized calcium were VTE independent predictors. Proteinuria and serum albumin cut-offs, and positive and negative predictive values (PPV and NPV) for VTE were 9.0 g/24 h (30 % PPV and 90 % NPV) and 1.5 g/dL (69 % PPV and 93 % NPV).
Conclusions
The rate of VTE incidence of 4.4 per 100 patient-years found in this prospective study confirms the idiopathic nephrotic syndrome as a thromboembolism-generating condition. Severe and unremitting proteinuria and hypoalbuminemia, low antithrombin III activity, and, surprisingly, high ionized calcium are independent VTE predictors. |
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ISSN: | 0301-1623 1573-2584 |
DOI: | 10.1007/s11255-013-0574-0 |