title: Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome.
abstract: Prior small studies have suggested an association between low serum albumin and increased risk of venous thromboembolic (VTE) events in patients with nephrotic syndrome (NS).
  
  
  
  From a nationally representative prospective cohort of over 3 million US veterans with baseline estimated glomerular filtration rate (eGFR) ≥60 mL/min/1.73 m 2 , we identified 7037 patients with NS based on ICD-9 codes. Association between serum albumin and risk of incident VTE was assessed using Cox regression analysis with adjustments for age, gender, race, comorbidities, eGFR, body mass index and anticoagulant treatment.
  
  
  
  Mean age was 57 ± 11 years, patients were 96% male, 32% African-American and 60% diabetic. There were a total of 158 VTE events over a median follow-up of 8.1 years; 16 events [absolute event rate (AER) 4.1%, event rate 8.5/1000 patient-years (PY)] in patients with albumin <2.5 g/dL, 18 events (AER 3.4%, event rate 5.7/1000 patient-years) in patients with albumin 2.5-2.99 g/dL, 89 events (AER 2.5%, event rate 3.4/1000 patient-years) in patients with albumin 3-3.99 g/dL and 35 events (AER 1.4%, event rate 1.9/1000 patient-years) in patients with albumin ≥4 g/dL. Compared with patients with albumin ≥4 g/dL, those with albumin levels of 3-3.99 g/dL [adjusted hazard ratio (HR): 1.51, 95% confidence interval (CI): 1.01-2.26], 2.5-2.99 g/dL (HR: 2.24, 95% CI: 1.24-4.05) and <2.5 g/dL (HR: 2.79, 95% CI: 1.45-5.37) experienced a linearly higher risk of VTE events.
  
  
  
  Lower serum albumin is a strong independent predictor for VTE events in NS. The risk increases proportionately with declining albumin levels. Clinical trials are needed to determine benefit of prophylactic anticoagulation in NS patients with moderately lower serum albumin levels.
authors.affiliation: Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.
authors.forename: Geeta
authors.initials: G
authors.lastname: Gyamlani
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Miklos Z
authors.initials: MZ
authors.lastname: Molnar
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Jun L
authors.initials: JL
authors.lastname: Lu
authors.affiliation: Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Keiichi
authors.initials: K
authors.lastname: Sumida
authors.affiliation: Division of Nephrology, University of California, Irvine, CA, USA.
authors.forename: Kamyar
authors.initials: K
authors.lastname: Kalantar-Zadeh
authors.affiliation: Nephrology Section, Memphis Veterans Affairs Medical Center, Memphis, TN, USA.|Division of Nephrology, University of Tennessee Health Science Center, Memphis, TN, USA.
authors.forename: Csaba P
authors.initials: CP
authors.lastname: Kovesdy
mesh_terms: D000368:Aged; D000925:Anticoagulants / Q000627:therapeutic use; D005260:Female; D005919:Glomerular Filtration Rate; D006801:Humans; D008297:Male; D008875:Middle Aged; D009404:Nephrotic Syndrome / Q000150:complications*; D011446:Prospective Studies; D012307:Risk Factors; D012709:Serum Albumin / Q000032:analysis*; D054556:Venous Thromboembolism / Q000097:blood* / Q000175:diagnosis / Q000188:drug therapy / Q000209:etiology
chemical_list: D000925:Anticoagulants; D012709:Serum Albumin
keywords: cohort; nephrotic syndrome; risk factors; serum albumin; venous thromboembolism