Risk factors for venous thromboembolism in patients with nephrotic syndrome: a retrospective cohort study

Abstract

Background Nephrotic syndrome is associated with an increased risk of venous thromboembolism (VTE). However, the risk factors of VTE in nephrotic syndrome, other than hypoalbuminemia and severe proteinuria, are not well established. Therefore we aimed to investigate the risk factors of VTE in patients with nephrotic syndrome. Methods This retrospective cohort study used data from a Japanese nationwide claims database. We identified patients ≥18 years of age hospitalized with nephrotic syndrome. Through multivariable logistic regression, we determined the risk factors of VTE in patients with nephrotic syndrome during hospitalization. Results Of the 7473 hospitalized patients with nephrotic syndrome without VTE, 221 (3.0%) developed VTE. In the VTE group, 14 (6.3%), 11 (5.0%) and 198 (89.6%) patients developed pulmonary embolism, renal vein thrombosis and deep vein thrombosis, respectively. We found that female sex {odds ratio [OR] 1.39 [95% confidence interval (CI) 1.05–1.85]}, body mass index (BMI) ≥30 [OR 2.01 (95% CI 1.35–2.99)], acute kidney injury [AKI; OR 1.67 (95% CI 1.07–2.62)], sepsis [OR 2.85 (95% CI 1.37–5.93)], lupus nephritis [OR 3.64 (95% CI 1.58–8.37)] and intravenous corticosteroids use [OR 2.40 (95% CI 1.52–3.80)] were associated with a significantly higher risk of developing VTE. Conclusions In patients with nephrotic syndrome, female sex, BMI ≥30, AKI, sepsis, lupus nephritis and intravenous corticosteroid use may help evaluate the risk of VTE.

Comparison of Patients with Hospital-Recorded Nephrotic Syndrome and Patients with Nephrotic Proteinuria and Hypoalbuminemia: A Nationwide Study in Denmark

“…The histopathological findings in both our cohorts were similar to those reported in patients with NS in the Netherlands (8), and Japan (10,22), with the most common being: minimal change disease, membranous nephropathy, mesangioproliferative glomerulopathy, and focal segmental glomerulosclerosis, possibly reflecting that patients with biopsy in both cohorts were selected for nephrology review. Similarly to previous studies, diabetic nephropathy was rarely reported in pathology records despite high prevalence of diabetes in our cohorts, likely due to a reluctance to perform kidney biopsies in patients with diabetes (8)(9)(10).…”

“…Nephrotic syndrome (NS) is a clinical diagnosis defined by biochemical criteria of nephrotic proteinuria (>3.5 gram per day), hypoalbuminemia, and the presence of edema (1,2). Data on the occurrence and prognosis of NS in adults are limited (3), and previous epidemiological studies of NS have focused on patients with NS recorded in hospital or pathology databases (4)(5)(6)(7)(8)(9)(10). However, NS can present insidiously, and patients may seek the help of a range of specialists before receiving specialist care from hospital doctors.…”

Comparative effectiveness and safety of edoxaban, rivaroxaban, and apixaban in patients with venous thromboembolism: A cohort study

“…The following seven types of diagnostic information are recorded only in the DPC claims: “main condition,” “other condition,” “trigger‐for‐hospitalization condition,” “most resource‐consuming condition,” “second most resource‐consuming condition,” “comorbidities present on admission,” and “conditions occurring after admission.” Patients in the database can be tracked as long as they are treated in the same hospital. The database has been used to evaluate cardiovascular issues 20,21 . For the present study, the study protocol was approved by the ethics committee of Kyoto University Graduate School and Faculty of Medicine (approval number: R2610), but informed consent was not required because the data were anonymous.…”

“…Because no validation studies on the definition of VTE recurrence have been conducted in Japan, this outcome was determined in consultation with an expert cardiologist, using a combination of the following two components: (1) inpatient diagnosis recorded in the DPC claim of VTE as "main condition," "trigger-for-hospitalization condition," "most resource-consuming condition," or "conditions occurring after admission"; and (2) imaging procedure codes during hospitalization. 21,22 We excluded recurrent VTE during hospitalization of the index VTE to ensure one VTE episode per hospitalization. As in the previous study, 14 we did not include VTE diagnoses in the outpatient setting because they might imply not a recurrence but a follow-up visit.…”

Venous Thromboembolism in Kidney Diseases and Genetic Predisposition

“…While most studies indicated that the higher proteinuria and lower serum albumin could predict VTE [33, 34], female gender, body mass index over 30, acute kidney injury, nephritis associated with lupus, sepsis, and the use of intravenous corticosteroid may contribute to the risk of developing VTE according to a recent study [35]. In addition, histopathological subtype was an independent risk factor for occurring VTE, even adjusted for other factors (history of cancers, proteinuria, patient’s gender, and serum albumin), with the highest risk in MN groups [36].…”