Daneschvar H Leon, Seddighzadeh Ali, Piazza Gregory, Goldhaber Samuel Z
Cardiovascular Medicine Division, Department of Medicine, Brigham and Women's Hospital, Harvard Medical School, Boston, MA 02115, USA.
Thromb Haemost. 2008 Jun;99(6):1035-9. doi: 10.1160/TH08-02-0107.
Deep vein thrombosis (DVT) is a poorly understood complication of chronic kidney disease (CKD). The objective of our analysis was to profile DVT patients with and without CKD. We defined CKD as patients requiring dialysis or patients having nephrotic syndrome. We compared 268 patients with CKD (184 patients with dialysis-dependent renal disease and 84 with nephrotic syndrome) to 4,307 patients with preserved renal function from a prospective United States multicenter deep venous thrombosis (DVT) registry. Compared with non-CKD patients, CKD patients with DVT were younger (median age 62 vs. 69 years, p < 0.0001), more often African-American (p < 0.0001), and more often Hispanic (p = 0.0003). CKD patients underwent surgery more frequently in the three months prior to developing DVT (48.9% vs. 39.0%, p = 0.001) and more often had concomitant congestive heart failure (20.9% vs. 14.6%, p = 0.005). CKD patients suffered upper extremity DVT more frequently (30.0% vs. 10.8%, p < 0.0001). Patients with CKD presented less often with typical DVT symptoms of extremity discomfort (42.9% vs. 52.4%, p = 0.003) and difficulty ambulating (5.4% vs. 10.1%, p = 0.01). Prophylaxis rates prior to DVT were similarly low in CKD and non-CKD patients (44.2% vs. 38.0%, p = 0.06). Future studies of DVT in CKD patients should explore novel strategies for improving prophylaxis utilization and the detection of DVT in this special population.
深静脉血栓形成（DVT）是慢性肾脏病（CKD）一种了解甚少的并发症。我们分析的目的是描述伴或不伴CKD的DVT患者的特征。我们将CKD定义为需要透析的患者或患有肾病综合征的患者。我们将268例CKD患者（184例依赖透析的肾病患者和84例肾病综合征患者）与来自美国一项前瞻性多中心深静脉血栓形成（DVT）登记研究的4307例肾功能正常的患者进行了比较。与非CKD患者相比，患有DVT的CKD患者更年轻（中位年龄62岁对69岁，p<0.0001），非裔美国人比例更高（p<0.0001），西班牙裔比例更高（p=0.0003）。CKD患者在发生DVT前三个月内接受手术的频率更高（48.9%对39.0%，p=0.001），并发充血性心力衰竭的情况更常见（20.9%对14.6%，p=0.005）。CKD患者上肢DVT的发生率更高（30.0%对10.8%，p<0.0001）。CKD患者出现肢体不适这一典型DVT症状的情况较少（42.9%对52.4%，p=0.003），行走困难的情况也较少（5.4%对10.1%，p=0.01）。CKD患者和非CKD患者在DVT发生前的预防率同样较低（44.2%对38.0%，p=0.06）。未来对CKD患者DVT的研究应探索改善预防措施应用及在这一特殊人群中检测DVT的新策略。
