|
Title Anticoagulation Prophylaxis against Venous Thromboembolism in Nephrotic Glomerular Disease: A single center experience |
|
Type Poster Presentation |
|
Theme 18th Asian Colloquium in Nephrology (18th ACN 2019) |
|
Topic Chronic Kidney Disease: Glomerular, Tubulointerstitial and Inherited Kidney disorders |
|
Main Author Rui Zhi Ng1 |
|
Presenting Author Rui Zhi Ng1 |
|
Co-Author Jason Chon Jun Choo1 Irene Yanjia Mok1 Cynthia Ciwei Lim1 |
|
Department / Institution / Country Renal Medicine / Singapore General Hospital / Singapore1 |
|
Abstract Content: Introduction, Method, Result, Conclusion Background: Venous thromboembolism (VTE) is known to be associated with nephrotic syndrome, especially in idiopathic membranous nephropathy (iMN). However, its incidence varies widely and consensus on VTE prophylaxis in conditions other than iMN is lacking. Thus we aimed to evaluate the use and outcomes of anticoagulation prophylaxis in nephrotic glomerulonephritides. Methods: Retrospective study of 234 adults with nephrotic syndrome (serum albumin ≤30 g/L and urine protein-to-creatinine ratio >3.5 g/g or urine protein >3.5 g/24h) due to biopsy-proven glomerular disease between January 2011 and August 2014. Clinical, laboratory and pharmacotherapy data were retrieved from electronic medical records. Symptomatic VTE was confirmed with diagnostic imaging. Results: Median age was 50.6 (IQR 37.1, 64.6) years and 45.7% were male. Among 32 individuals (14%) prescribed prophylactic anticoagulation, the majority had membranous nephropathy (28.1%), lupus nephrits (21.9%) and minimal change disease or focal segmental glomerulosclerosis (18.8%). These patients were more likely to have persistently low serum albumin <25 g/dL at 3 months after biopsy (46.7% vs. 25.8%, p=0.02) and tended to have membranous nephropathy (28.1% vs. 14.4%, p=0.05) and higher body mass index [26.1 (24.3, 30.4) vs. 24.4 (21.7, 27.6) kg/m2, p=0.05]. Age, gender, degree of proteinuria and ATRIA bleeding risk score were not associated with use of anticoagulation prophylaxis. During follow up of 48.6 (40.3, 62.1) months, symptomatic VTE occurred in 6 (3.0%) of those without prophylactic anticoagulation compared to none among those who had (p=1.00), while bleeding episodes tended to occur more frequently in those who had anticoagulation prophylaxis (21.9% vs. 13.9%, p=0.28). Conclusion: Incidence of symptomatic VTE was low among individuals with nephrotic glomerulonephritides and clinical benefit of prophylactic anticoagulation in these patients is uncertain. |