title: Serum D-dimer concentrations in nephrotic syndrome track with albuminuria, not estimated glomerular filtration rate.
abstract: BACKGROUND
  The nephrotic syndrome is associated with an increased risk of venous and arterial thrombosis. There are little published data on the distribution, interpretation or determinants of serum D-dimer levels in patients with the nephrotic syndrome. We aimed to describe this relationship.
  
  
  METHODS
  This was a cross-sectional study of 100 patients with the nephrotic syndrome. Multivariate linear regression was used to evaluate for independent predictors of elevated D-dimer levels. Patients were observed for a period of 2 years after the baseline measurement of D-dimer level to assess for subsequent clinically evident thrombosis.
  
  
  RESULTS
  On univariate linear regression, D-dimer elevation was associated with age in years β (95% CI) 0.02 (0.016, 0.03), log-transformed urinary protein:creatinine ratio in g/g 0.439 (0.32, 0.558) and inversely with serum albumin in g/l -0.05 (-0.073, -0.035) and estimated glomerular filtration rate (eGFR) in ml/min/1.73 m(2) -0.01 (-0.016, -0.003). On multivariate linear regression, age in years β (95% CI) 0.019 (0.012, 0.026), serum albumin in g/l -0.023 (-0.043, -0.003), and log-transformed urinary protein:creatinine ratio in g/g 0.266 (0.124, 0.408) were independently associated with elevated D-dimer levels.
  
  
  CONCLUSIONS
  D-dimer levels are commonly raised in the nephrotic syndrome in the absence of clinically evident thrombosis, and are independently associated with age, degree of proteinuria and serum albumin, but not with eGFR. Baseline levels of D-dimer did not predict subsequent episodes of clinically evident thrombosis after 2 years of follow-up.
authors.affiliation: Cardiac Renal Centre, Department of Renal Medicine, Cork University Hospital, Cork, Ireland. donalsexton0@hotmail.com
authors.forename: D J
authors.initials: DJ
authors.lastname: Sexton
authors.forename: M R
authors.initials: MR
authors.lastname: Clarkson
authors.forename: M J
authors.initials: MJ
authors.lastname: Mazur
authors.forename: W D
authors.initials: WD
authors.lastname: Plant
authors.forename: J A
authors.initials: JA
authors.lastname: Eustace
mesh_terms: D000328:Adult; D000367:Age Factors; D000368:Aged; D000419:Albuminuria / Q000097:blood*; D003404:Creatinine / Q000652:urine; D003430:Cross-Sectional Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005919:Glomerular Filtration Rate; D006801:Humans; D016014:Linear Models; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009404:Nephrotic Syndrome / Q000097:blood* / Q000652:urine; D011507:Proteinuria / Q000097:blood; D012709:Serum Albumin / Q000378:metabolism
chemical_list: D005338:Fibrin Fibrinogen Degradation Products; D012709:Serum Albumin; C036309:fibrin fragment D; D003404:Creatinine