Venous Thrombosis: Decreased Kidney Function Raises Risk

Frits R. Rosendaal PhD Department of Clinical Epidemiology Leiden University Medical Center, Leiden, The NetherlandsMedicalResearch.com Interview with:
Frits R. Rosendaal PhD
Department of Clinical Epidemiology
Leiden University Medical Center,
Leiden, The Netherlands


MedicalResearch.com: What are the main findings of the study?

Answer: In our study, we found that moderately to severely decreased kidney function was associated with a 2.6-fold (95%CI 2.0-3.5) increased risk of venous thrombosis as compared with normal kidney function. Several hemostatic factors showed a procoagulant shift with decreasing kidney function, most notably factor VIII and von Willebrand factor. We showed that the increased risk of venous thrombosis in chronic kidney disease could not be explained by confounding factors such as body mass index, diabetes, hospitalization, or corticosteroid use. However, we found that factor VIII and von Willebrand factor fully explained the increased risk of venous thrombosis associated with impaired kidney function.

MedicalResearch.com: Were any of the findings unexpected?

Answer: To our knowledge, this is the first study that investigated increased levels of hemostatic factors as an explanation for the risk of venous thrombosis in individuals with a decreased kidney function. The increased risk of venous thrombosis in individuals with moderately to severely decreased kidney function was not unexpected. However, the finding that factor VIII and von Willebrand factor fully explained the association between kidney function and venous thrombosis is, as far as we know, a novel finding.

MedicalResearch.com: What should clinicians and patients take away from your report?

Answer: A 2.6-fold increased risk of venous thrombosis for moderately to severely decreased kidney function probably does not justify thromboprophylaxis in all patients with decreased kidney function (since such a strategy is unlikely to outweigh the bleeding risk). However, our data imply that chronic kidney disease is a procoagulant state, for which patients may receive thromboprophylaxis when encountering a high venous thrombosis risk situation.

MedicalResearch.com: What recommendations do you have for future research as a result of this study?

Answer: First, findings from our study reinforce that that future studies should aim to identify high risk groups within patients with chronic kidney disease that may benefit from thromboprophylaxis. Second, studies that investigate whether a procoagulant state (and hence venous thrombosis risk) can be downsized in patients with chronic kidney disease by means of cardiovascular drugs that are often given to patients with chronic kidney disease may be of interest (e.g. statins). Third, it would be of interest to further clarify the underlying mechanism, i.e. explain how kidney disease leads to high levels of factor VIII and von Willebrand factor.

Citation:

Role of Hemostatic Factors on the Risk of Venous Thrombosis in Persons with Impaired Kidney Function

Gürbey Ocak, Carla Y. Vossen, Willem M. Lijfering, Marion Verduijn, Friedo W. Dekker, Frits R. Rosendaal, and Suzanne C. Cannegieter

Circulation. 2013;CIRCULATIONAHA.113.002385published online before print November 8 2013, doi:10.1161/CIRCULATIONAHA.113.002385