Patients with primary membranous nephropathy are at high risk of cardiovascular events

Abstract

Here we conducted a retrospective study to examine the risk of cardiovascular events (CVEs) relative to that of end-stage renal disease (ESRD) in patients with primary membranous nephropathy, in a discovery cohort of 404 patients. The cumulative incidence of CVEs was estimated in the setting of the competing risk of ESRD with risk factors for CVEs assessed by multivariable survival analysis. The observed cumulative incidences of CVEs were 4.4%, 5.4%, 8.2%, and 8.8% at 1, 2, 3, and 5 years respectively in the primary membranous nephropathy cohort. In the first 2 years after diagnosis, the risk for CVEs was similar to that of ESRD in the entire cohort, but exceeded it among patients with preserved renal function. Accounting for traditional risk factors and renal function, the severity of nephrosis at the time of the event (hazard ratio 2.1, 95% confidence interval 1.1 to 4.3) was a significant independent risk factor of CVEs. The incidence and risk factors of CVEs were affirmed in an external validation cohort of 557 patients with primary membranous nephropathy. Thus early in the course of disease, patients with primary membranous nephropathy have an increased risk of CVEs commensurate to, or exceeding that of ESRD. Hence, reduction of CVEs should be considered as a therapeutic outcome measure and focus of intervention in primary membranous nephropathy.

Venous Thromboembolism in Primary Nephrotic Syndrome - Is the Risk High Enough to Justify Prophylactic Anticoagulation?

“…We are therefore confident that there is a low likelihood that we have missed episodes of clinically significant VTE. We did not assess the incidence of arterial thrombus, and this has previously been reported to be increased in patients with NS and may benefit from prophylactic anticoagulation [4,21]. Our study focused on patients with a histological diagnosis of a primary glomerulonephritis in whom the main indication for biopsy was NS.…”

Pharmacological treatment of primary membranous nephropathy in 2016

“…After CNI withdrawal, only three patients suffered from a relapse (19,23, and 28 months after rituximab treatment), all of them were successfully treated with a second course of rituximab.…”

“…Lee et al developed a useful tool to provide a more personalized decision about the initiation of prophylactic anticoagulation [18]. Recently, it became clear that the risk of arterial thrombosis is also high [19]. Prevention with platelet aggregation inhibition must be considered [20].…”

Acute arterial cardiovascular events risk in patients with primary membranous nephropathy

“…Other events occurred up to 11 years of follow up. The concept of ‘early’ versus ‘late’ CV events was previously described by Lee et al . and other studies.…”

“…10,11 More recently, large studies provided evidence supporting the high risk of arterial thrombosis in patients with nephrotic syndrome and in particular patients with primary MN. 12,13 In this study we aim to review the incidence of cardiovascular (CV) arterial thrombosis in our nephrotic patients with primary MN and assess the risk factors and how to address these factors.…”