High Absolute Risks and Predictors of Venous and Arterial Thromboembolic Events in Patients With Nephrotic Syndrome: Results From a Large Retrospective Cohort Study Export

@article{citeulike:3790875, abstract = {Background-- No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of VTE and ATE in a large, single-center, retrospective cohort study and attempted to identify predictive factors in these patients. Methods and Results-- A total of 298 consecutive patients with nephrotic syndrome (59\% men; mean age, 42{+/-}18 years) were enrolled. Mean follow-up was 10{+/-}9 years. Nephrotic syndrome was defined by proteinuria [\≥]3.5 g/d, and patients were classified according to underlying histological lesions accounting for nephrotic syndrome. Objectively verified symptomatic thromboembolic events were the primary study outcome. Annual incidences of VTE and ATE were 1.02\% (95\% confidence interval, 0.68 to 1.46) and 1.48\% (95\% confidence interval, 1.07 to 1.99), respectively. Over the first 6 months of follow-up, these rates were 9.85\% and 5.52\%, respectively. Proteinuria and serum albumin levels tended to be related to VTE; however, only the predictive value of the ratio of proteinuria to serum albumin was significant (hazard ratio, 5.6; 95\% confidence interval, 1.2 to 26.2; P=0.03). In contrast, neither the degree of proteinuria nor serum albumin levels were related to ATE. Sex, age, hypertension, diabetes, smoking, prior ATE, and estimated glomerular filtration rate predicted ATE (P[\≤]0.02). Conclusions-- This study verifies high absolute risks of symptomatic VTE and ATE that were remarkably elevated within the first 6 months. Whereas the ratio of proteinuria to serum albumin predicted VTE, estimated glomerular filtration rate and multiple classic risk factors for atherosclerosis were predictors of ATE. 10.1161/CIRCULATIONAHA.107.716951}, author = {Mahmoodi, Bakhtawar K. and Ten and Waanders, Femke and Veeger, Nic J. and Brouwer, Jan-Leendert P. and Vogt, Liffert and Navis, Gerjan and van der Meer, Jan}, citeulike-article-id = {3790875}, citeulike-linkout-0 = {http://dx.doi.org/10.1161/CIRCULATIONAHA.107.716951}, citeulike-linkout-1 = {http://circ.ahajournals.org/cgi/content/abstract/117/2/224}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/18158362}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=18158362}, doi = {10.1161/CIRCULATIONAHA.107.716951}, journal = {Circulation}, keywords = {dvt, gn, ns}, month = {January}, number = {2}, pages = {224--230}, posted-at = {2008-12-16 05:30:53}, priority = {2}, title = {High Absolute Risks and Predictors of Venous and Arterial Thromboembolic Events in Patients With Nephrotic Syndrome: Results From a Large Retrospective Cohort Study}, url = {http://dx.doi.org/10.1161/CIRCULATIONAHA.107.716951}, volume = {117}, year = {2008} }

TY - JOUR ID - citeulike:3790875 L3 - citeulike-article-id:3790875 N2 - Background-- No data are available on the absolute risk of either venous thromboembolism (VTE) or arterial thromboembolism (ATE) in patients with nephrotic syndrome. Reported risks are based on multiple case reports and small studies with mostly short-term follow-up. We assessed the absolute risk of VTE and ATE in a large, single-center, retrospective cohort study and attempted to identify predictive factors in these patients. Methods and Results-- A total of 298 consecutive patients with nephrotic syndrome (59% men; mean age, 42{+/-}18 years) were enrolled. Mean follow-up was 10{+/-}9 years. Nephrotic syndrome was defined by proteinuria [≥]3.5 g/d, and patients were classified according to underlying histological lesions accounting for nephrotic syndrome. Objectively verified symptomatic thromboembolic events were the primary study outcome. Annual incidences of VTE and ATE were 1.02% (95% confidence interval, 0.68 to 1.46) and 1.48% (95% confidence interval, 1.07 to 1.99), respectively. Over the first 6 months of follow-up, these rates were 9.85% and 5.52%, respectively. Proteinuria and serum albumin levels tended to be related to VTE; however, only the predictive value of the ratio of proteinuria to serum albumin was significant (hazard ratio, 5.6; 95% confidence interval, 1.2 to 26.2; P=0.03). In contrast, neither the degree of proteinuria nor serum albumin levels were related to ATE. Sex, age, hypertension, diabetes, smoking, prior ATE, and estimated glomerular filtration rate predicted ATE (P[≤]0.02). Conclusions-- This study verifies high absolute risks of symptomatic VTE and ATE that were remarkably elevated within the first 6 months. Whereas the ratio of proteinuria to serum albumin predicted VTE, estimated glomerular filtration rate and multiple classic risk factors for atherosclerosis were predictors of ATE. 10.1161/CIRCULATIONAHA.107.716951 IS - 2 JF - Circulation EP - 230 TI - High Absolute Risks and Predictors of Venous and Arterial Thromboembolic Events in Patients With Nephrotic Syndrome: Results From a Large Retrospective Cohort Study VL - 117 SP - 224 KW - dvt KW - gn KW - ns AU - Mahmoodi, Bakhtawar AU - Ten AU - Waanders, Femke AU - Veeger, Nic AU - Brouwer, Jan-Leendert AU - Vogt, Liffert AU - Navis, Gerjan AU - van der Meer, Jan PY - 2008/01/15/ UR - http://dx.doi.org/10.1161/CIRCULATIONAHA.107.716951 ER -