Risk factors for predicting venous thromboembolism in patients with nephrotic syndrome: focus on haemostasis-related parameters.
OBJECTIVE
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.
Gener
G
Ismail
Gabriel
G
Mircescu
Alecse Valerian
AV
Ditoiu
Beatrice Dorina
BD
Tacu
Roxana
R
Jurubita
Mihai
M
Harza
D000328:Adult; D000368:Aged; D000990:Antithrombin III / Q000378:metabolism; D002118:Calcium / Q000097:blood; D005260:Female; D005500:Follow-Up Studies; D006487:Hemostasis; D006801:Humans; D034141:Hypoalbuminemia / Q000453:epidemiology; D015994:Incidence; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000097:blood / Q000453:epidemiology* / Q000652:urine; D011237:Predictive Value of Tests; D011446:Prospective Studies; D011507:Proteinuria / Q000453:epidemiology; D012372:ROC Curve; D012307:Risk Factors; D054556:Venous Thromboembolism / Q000097:blood / Q000453:epidemiology* / Q000652:urine
D000990:Antithrombin III; D002118:Calcium