Impact of chronic kidney disease on the risk of clinical outcomes in patients with cancer‐associated venous thromboembolism during anticoagulant treatment

Abstract

Summary Background Information on recurrent venous thromboembolic events (VTEs) and major bleeding risks during anticoagulant treatment in patients with cancer‐associated VTEs and chronic kidney disease (CKD) is scarce, although it is of relevance in establishing better tailored management strategies in these patients. Objectives We compared risks of recurrent VTEs and major bleeds in cancer‐associated VTE patients with and without CKD. Methods A total of 1684 patients diagnosed with a cancer‐associated VTE between 2001 and 2011 were followed for 180 days after VTE diagnosis. Patients were treated mainly with low‐molecular‐weight heparin (LMWH) or vitamin‐K antagonists (VKA). Primary outcomes were recurrent VTE and major bleeding. Secondary outcome was fatal bleeding. Results Recurrent VTEs occurred in 15.9/100 patient years (py) in patients without CKD (eGFR > 60 mL min−1), 19.5/100 py in those with CKD stage 3A (eGFR 45–60 mL min−1), 14.9/100 py in those with CKD 3B (eGFR 30–45 mL min−1), and 6.8/100 py in patients with CKD 4–5 (eGFR < 30 mL min−1). Major bleeding occurred in 11.4/100 py in patients without CKD, 18.5/100 py in those with CKD stage 3A, 16.0/100 py in those with CKD 3B, and 40.8/100 py in patients with CKD 4–5. Fatal bleeding occurred in 1.1/100 py, 3.4/100 py, 6.3/100 py and 15.7/100 py, respectively. These increased bleeding risks in CKD patients were mainly observed in those on LMWH treatment, not VKA. Conclusions The risk of major bleeding was increased in CKD patients with VTE and cancer, and was most prominent in those treated with LMWH and an eGFR < 30 mL min−1. These results indicate that LMWH should be used with caution in this specific population.

International clinical practice guidelines including guidance for direct oral anticoagulants in the treatment and prophylaxis of venous thromboembolism in patients with cancer

“…One prospective study 131 investigated the impact of renal insuffi ciency on the safety and effi cacy of anticoagulant therapy by comparing the risks of recurrent VTE and bleeding in 1279 patients with cancer with and without chronic kidney disease. Risk of major bleeds and fatal bleeds increased with the stage of chronic kidney disease.…”

Evaluation of risk factors and assessment models for predicting venous thromboembolism in lung cancer patients

“…Moreover, in the present study the impact of comorbidities on the risk of VTE development was analyzed. The association between CKD and VTE occurrence has previously been demonstrated in the general population [ 35 ], but in cancer patients with CKD the data are contradictory [ 36 , 37 ]. In the univariate model, the patients with lung cancer and CKD had an above 4.0-fold increased risk of VTE.…”

Osthole protects against inflammation in a rat model of chronic kidney failure via suppression of nuclear factor-κB, transforming growth factor-β1 and activation of phosphoinositide 3-kinase/protein kinase B/nuclear factor (erythroid-derived 2)-like 2 signaling

“…CRF refers to chronic progressive renal parenchymal damage and occurs for various reasons (13). Its primary manifestations include retention of metabolites and poisonous substances, water imbalance, electrolyte and acid-base disturbance, and abnormity of endocrine function (14). It has been predicted that 10% people suffer from chronic renal disease, and the morbidity of CRF in China is ~1/10,000 (15).…”