Adults with nephrotic syndrome at greater risk of thromboembolism, bleeding

The risk of arterial thromboembolism, venous thromboembolism, and bleeding is higher in adults with nephrotic syndrome than the general population, a study has found. However, the mechanisms and consequences of this association warrant further research.

Adults with first-time recorded nephrotic syndrome from admissions, outpatient clinics, or emergency department visits in Denmark during 1995–2018 were identified and included in this matched cohort study. Each patient was matched by age and sex with 10 individuals from the general population.

The researchers estimated 10-year cumulative risks of recorded arterial thromboembolism, venous thromboembolism, and bleeding accounting for the competing mortality risk. They used Cox models to calculate crude and adjusted hazard ratios (HRs) of the outcomes in patients with nephrotic syndrome relative to comparators.

The 1-year risk of arterial thromboembolism among 3,967 adults with first-time nephrotic syndrome was 4.2 percent (95 percent CI, 3.6‒4.8), while that of venous thromboembolism and bleeding was 2.8 percent (95 percent CI, 2.3‒3.3) and 5.2 percent (95 percent CI, 4.5‒5.9), respectively.

The 10-year risk of arterial thromboembolism was 14.0 percent (95 percent CI, 12.8‒15.2), while that of venous thromboembolism and bleeding was 7.7 percent (95 percent CI, 6.8‒8.6) and 17.0 percent (95 percent CI, 15.7‒18.3), respectively, with highest risks of ischaemic stroke (8.1 percent), myocardial infarction (6.0 percent), and gastrointestinal bleeding (8.2 percent).

After adjusting for confounders, patients with nephrotic syndrome showed higher rates of arterial thromboembolism (adjusted HR, 3.11, 95 percent CI, 2.60‒3.73), venous thromboembolism (adjusted HR, 7.11, 95 percent CI, 5.49‒9.19), and bleeding (adjusted HR, 4.02, 95 percent CI, 3.40‒4.75) during the first year.