**2.1.1 Chronic kidney disease and venous thromboembolism**

There are few prospective studies about this association, with this objective and using the data from the Longitudinal Investigation of Thromboembolism Etiology Study, 19,073 middle-aged and elderly adults were categorized on the basis of the determination of the glomerular flltration rate and cystatin C (data avalaible in 4,734 participants). During a mean follow up time of 11.8 years, 413 participants developed venous thromboembolism (41 % idiopathic and 59% secondary). Compared with the participants with normal kidney function, the relative risk for venous thromboembolism was 1.28 (95% confidence interval) for those with mildly decrease kidney function and 2.09 for those with stage 3 or 4 of chronic kidney disease. The authors concluded that middle –age and elderly patients with chronic kidney disease stages 3 through 4 evidence all increased risk for incident venous thromboembolism, suggesting that prophylaxis may **be** particularly important in this population (Wattanakit, 2008).

Similar results were reported by Folsom et al, in a prospective cohort of 10,700 patients, in whom estimated the glomerular filtration rate from prediction equations based on serum creatinine or cystatin C, and follow up for the occurrence of venous thromboembolism for over a median of 8.3 years. The adjusted hazard ratios of total venous thromboembolism and estimated glomerular filtration rate based in cystatin C was 1.0 for normal kidney function, 1.4 for mildly impaired renal function and 1.94 for stage 3 and 4 of chronic kidney disease, these hazard ratios were moderately attenuated to 1.0, 1.26 and 1.6 respectively with adjustment for hormone replacement therapy, diabetes and body mass index. Association between chronic kidney disease, based on estimated glomerular filtration rate using cystatin C, and venous thromboembolism were slightly stronger for idiopathic venous thromboembolism than for secondary venous thromboembolism. In contrast, creatinine glomerular filtration rate was no associate with total venous thromboembolism occurrence.(Foslom, 2010).

Another prospective cohort study 8,495 subjects whit chronic kidney disease stages 1 to 3 in which renal function and albuminuria were assessed, they concluded that stages 1 or 2 of chronic kidney disease are risk factors for venous thromboembolism in presence of albuminuria, and the risk of venous thromboemboslim is more related to albuminuria than to impaired glomerular filtration rate (Ocak 2010).

#### **2.1.2 End-stage renal disease and venous thromboembolism**

Independent of co-morbidity chronic dialysis patients have high risk for pulmonary embolism, in 1996 in the United States, the overall incidence rate of pulmonary embolism Pathophysiology and Clinical Aspects of 42 Venous Thromboembolism in Neonates, Renal Disease and Cancer Patients

Chronic kidney disease is common in the general population, affecting 13% of adults in the

There are several questions about the relation between venous thromboembolism and chronic kidney disease. Is the chronic kidney disease a risk factor for venous thromboembolism? What are the mechanisms involved in these diseases? And finally how

There are few prospective studies about this association, with this objective and using the data from the Longitudinal Investigation of Thromboembolism Etiology Study, 19,073 middle-aged and elderly adults were categorized on the basis of the determination of the glomerular flltration rate and cystatin C (data avalaible in 4,734 participants). During a mean follow up time of 11.8 years, 413 participants developed venous thromboembolism (41 % idiopathic and 59% secondary). Compared with the participants with normal kidney function, the relative risk for venous thromboembolism was 1.28 (95% confidence interval) for those with mildly decrease kidney function and 2.09 for those with stage 3 or 4 of chronic kidney disease. The authors concluded that middle –age and elderly patients with chronic kidney disease stages 3 through 4 evidence all increased risk for incident venous thromboembolism, suggesting that prophylaxis may **be** particularly important in this

Similar results were reported by Folsom et al, in a prospective cohort of 10,700 patients, in whom estimated the glomerular filtration rate from prediction equations based on serum creatinine or cystatin C, and follow up for the occurrence of venous thromboembolism for over a median of 8.3 years. The adjusted hazard ratios of total venous thromboembolism and estimated glomerular filtration rate based in cystatin C was 1.0 for normal kidney function, 1.4 for mildly impaired renal function and 1.94 for stage 3 and 4 of chronic kidney disease, these hazard ratios were moderately attenuated to 1.0, 1.26 and 1.6 respectively with adjustment for hormone replacement therapy, diabetes and body mass index. Association between chronic kidney disease, based on estimated glomerular filtration rate using cystatin C, and venous thromboembolism were slightly stronger for idiopathic venous thromboembolism than for secondary venous thromboembolism. In contrast, creatinine glomerular filtration rate was no associate with total venous thromboembolism

Another prospective cohort study 8,495 subjects whit chronic kidney disease stages 1 to 3 in which renal function and albuminuria were assessed, they concluded that stages 1 or 2 of chronic kidney disease are risk factors for venous thromboembolism in presence of albuminuria, and the risk of venous thromboemboslim is more related to albuminuria than

Independent of co-morbidity chronic dialysis patients have high risk for pulmonary embolism, in 1996 in the United States, the overall incidence rate of pulmonary embolism

**2.1 Epidemiology of thromboembolism associated to chronic kidney disease** 

**2.1.1 Chronic kidney disease and venous thromboembolism** 

United States between 1999 and 2004 (Coresh 2007).

to treat these patients?

population (Wattanakit, 2008).

occurrence.(Foslom, 2010).

to impaired glomerular filtration rate (Ocak 2010).

**2.1.2 End-stage renal disease and venous thromboembolism** 

was 149.9/100,000 dialysis patients, compared with 24.6/100,000 persons in the general population. In this study the younger dialysis patients had the greatest relative risk for pulmonary embolism (Tveit, 2002). Similar results by Allen et al, that showed an incidence of 8.3% of venous thromboembolism in dyalisis patiens (Allen, 1987).
