Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome

Gyamlani, Geeta; Molnar, Miklos Z.; Lü, Jun; Sumida, Keiichi; Kalantar-Zadeh, Kamyar; Kövesdy, Csaba P.

doi:10.1093/ndt/gfw227

Cited by 73 publications

(59 citation statements)

References 45 publications

(62 reference statements)

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“…(8)(9)(10)(11) Recent emerging evidence suggests that low serum albumin concentrations might be linked with an increased risk of VTE; however, the evidence has been conflicting. Whereas some studies have suggested an increased risk of VTE with low serum albumin concentrations, (12)(13)(14) other studies have shown no evidence of any associations. (9,10,15) In addition, majority of these studies were based on cross-sectional or retrospective designs or were conducted in populations with pre-existing diseases such as nephrotic syndrome and cancer.…”

Section: Introductionmentioning

confidence: 98%

“…(9,10,15) In addition, majority of these studies were based on cross-sectional or retrospective designs or were conducted in populations with pre-existing diseases such as nephrotic syndrome and cancer. (12)(13)(14)(15) However, in a recent elegant evaluation based on two population-based cohorts, Folsom and colleagues demonstrated low serum albumin to be a modest marker of increased VTE risk and speculated that the observed association might reflect a hyperinflammatory or a hypercoagulable state. (16) There were however some drawbacks of this study which included (i) inability to evaluate if inflammation might explain the findings, as there were no available measurements of C-reactive protein (CRP) in the study cohorts.…”

Section: Introductionmentioning

confidence: 99%

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Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

et al. 2018

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In middle-aged Caucasian men, low serum albumin is associated with an increased risk of VTE, consistent with a linear dose-response relationship. The association is independent of and not modified by inflammation. Key messages • Serum albumin may be associated with future risk of venous thromboembolism (VTE); however, the shape, nature, magnitude and consistency of the association is uncertain. • In a population-based prospective cohort study, low serum albumin was associated with an increased risk of VTE in a linear dose-response manner and this association was independent of and not modified by inflammation. • Serum albumin concentrations may play a role in the development of VTE.

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Section: Introductionmentioning

confidence: 98%

Section: Introductionmentioning

confidence: 99%

Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

et al. 2018

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“…19 Another study on NS patients also reported that serum albumin level of 3-3.99 g/dL would increase the thromboembolic event Correlation between serum albumin level and platelet aggregation value, assessed using ADP concentration of 1 μM in pediatric NS patients risk by 1.5 times, while serum albumin level of 2.5-2.99 g/dL would increase the thromboembolic event risk by 2.2 times, and serum albumin level below 2.5 g/dL would increase the risk by 2.79 times. 11 This study had several limitations. The sample size was considered small for assessing correlations between these variables.…”

Section: Discussionmentioning

confidence: 93%

Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome

Nainggolan

Sudarwati

Hilmanto

2019

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Background Nephrotic syndrome (NS) is the most common renal disease among children, and contributes to lifethreatening complications such as thromboembolic disease. Platelets are considered to be important agents in thrombotic events among NS patients. The gold standard assessment for platelet aggregation is the use of adenosine diphosphate (ADP) agonist, however, it is expensive and not accessible in smaller health facilities. Thus, other thrombosis parameters are needed. Previous studies suggested that low albumin increased the risk of thrombosis in NS patients. Objective To assess for a possible correlation between albumin level and platelet count as well as platelet aggregation. Methods This cross-sectional study was conducted in children with nephrotic syndrome who were admitted to the Pediatric Nephrology Department in Dr. Hasan Sadikin General Hospital, Bandung, West Java, from November 2017 to March 2018. Subjects were selected by consecutive sampling. Serum albumin, platelet count, and platelet aggregation were measured. Statistical analysis was conducted by Spearman's test. Results A total of 32 patients participated in the study, with mean age of 109 (SD 7.4) months. Most subjects were male (56%). Subjects' mean serum albumin level was 2.06 (SD 1.23) g/dL; mean platelet count was 453,062.5 (SD 187,443.90)/mm3; and mean platelet aggregation values for ADP agonist concentrations of 10, 5, 2.5, and 1 µM were 86.8 (SD 8.63)%, 82.4 (SD 15.33)%, 66.6 (SD 24.90)%, 34.95 (SD 31.69)%, respectively. Partial correlation analysis revealed significant negative associations between albumin and platelet count as well as platelet aggregation assessed with 1 µM of ADP concentration (P<0.001), with Spearman correlation coefficients of -0.641 and -0.634, respectively. Conclusion Serum albumin level has a moderately negative correlation with platelet count and platelet aggregation value. [Paediatr Indones. 2019;59:7-12; doi: http://dx.doi.

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“…A serum albumin concentration > 4 g/dL was shown to be associated with a low risk of VTE in ambulatory patients with non-hematologic malignancies [32]. Several studies reported that hypoalbuminemia was shown to be an independent risk factor for VTE in the general public [33] and patients with nephrotic syndrome [34]. However, these studies did not reveal whether hypoalbuminemia is not only a VTE risk factor but also a direct cause for VTE, because hypoalbuminemia may reflect inflammation [35] and urinary loss of albumin in kidney disease [34], which were reported the association with VTE [34,35].…”

Section: Discussionmentioning

confidence: 99%

Hypoalbuminemia for the prediction of venous thromboembolism and treatment of direct oral anticoagulants in metastatic gastric cancer patients

et al. 2019

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Background Venous thromboembolism (VTE) is highly associated with advanced gastric cancer (AGC) and is sometimes lethal. Predictors of VTE have not been identified, and the efficacy and safety of direct oral anticoagulants (DOACs) for AGC-associated VTE remain to be clarified. Methods A total of 188 AGC patients who started chemotherapy during the period from January 2014 to December 2017 in our institutions were retrospectively examined for the incidence of VTE, risk factors for VTE, and the efficacy and safety of DOAC-based anticoagulant therapy for VTE. Results Thirty-four patients (18%) were diagnosed with VTE at the start or during the course of chemotherapy (VTE group). More VTE group patients had a history of abdominal surgery and had moderate-severe ascites (32% versus 17%, 32% versus 14%, respectively) than non-VTE group patients (NVTE group). The mean serum albumin concentrations in the VTE group were significantly lower than NVTE group (3.38 mg/dL vs 3.65 mg/dL, respectively). Multivariate analysis showed that hypoalbuminemia was significantly correlated with VTE (P = 0.012). In the VTE group, 29 patients (85%) received anticoagulant therapy, including 24 patients treated with DOACs. No lethal VTE was observed in any patients. Thirteen patients (45%) terminated DOACs because of anemia or bleeding events, of whom eleven developed major bleeding. Median overall survivals of the VTE and NVTE groups were 9.63 months and 11.5 months, respectively (P = 0.262). Conclusion Hypoalbuminemia appears to be a risk factor for AGC-associated VTE. DOACs are effective to AGC-associated VTE, but careful observation of bleeding events is required.

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Association of serum albumin level and venous thromboembolic events in a large cohort of patients with nephrotic syndrome

Abstract: 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.

Cited by 73 publications

References 45 publications

Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

Inverse association between serum albumin and future risk of venous thromboembolism: interrelationship with high sensitivity C-reactive protein

Correlation of serum level of albumin with platelet count and platelet aggregation assessed by adenosine diphosphate agonist in children with nephrotic syndrome

Hypoalbuminemia for the prediction of venous thromboembolism and treatment of direct oral anticoagulants in metastatic gastric cancer patients

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