Венозные тромбоэмболические осложнения у пациентов с хронической болезнью почек: распространенность и особенности медикаментозного лечения

Джиоева О.Н., Орлова А.А., Рогожкина Е.А., Драпкина О.М. Венозные тромбоэмболические осложнения у пациентов с хронической болезнью почек: распространенность и особенности медикаментозного лечения. Терапевтический архив. 2022;94(1):129–134. DOI: 10.26442/00403660.2022.01.201358

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Dzhioeva ON, Orlova AA, Rogozhkina EA, Drapkina OM. Venous thromboembolic complications in patients with chronic kidney disease: prevalence and features of drug treatment. Terapevticheskii Arkhiv (Ter. Arkh.). 2022;94(1):129–134. DOI: 10.26442/00403660.2022.01.201358

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Аннотация

Статья представляет собой обсуждение проблемы венозных тромбоэмболических осложнений (ВТЭО) у больных хронической болезнью почек (ХБП), которая для нашей страны является значимой и насущной. Признаки ХБП отмечаются более чем у 1/3 пациентов с хронической сердечной недостаточностью; снижение функции почек наблюдается у 36% лиц в возрасте старше 60 лет, у лиц трудоспособного возраста снижение функции отмечается в 16% случаев, а при наличии сердечно-сосудистых заболеваний возрастает до 26%. Данные клинических исследований убедительно показывают, что ХБП является независимым фактором риска развития ВТЭО. Последнее десятилетие дало нам возможность наблюдать некую «революцию» в терапии ВТЭО, которая связана с появлением на рынке прямых пероральных антикоагулянтов, включающих ингибиторы фактора IIa (тромбина) и фактора Ха. Эти препараты одобрены Управлением по контролю пищевых продуктов и лекарств в США для лечения острой тромбоэмболии. Тем не менее пациенты с тяжелой ХБП (расчетная скорость клубочковой фильтрации <30 мл/мин) по-прежнему ограничены использованием нефракционированного гепарина и антагонистов витамина К, так как недостаточно данных в поддержку использования прямых пероральных антикоагулянтов в этой популяции.

Ключевые слова: хроническая болезнь почек, венозные тромбоэмболические осложнения, антикоагулянтная терапия, прямые оральные антикоагулянты

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The article is an opinion on the problem of venous thromboembolic (VTE) complications in patients with chronic kidney disease (CKD), which is significant and urgent for Russia. Signs of CKD are noted in more than 1/3 of patients with chronic heart failure; a decrease in kidney function is observed in 36% of people over the age of 60, in people of working age, a decrease in function is noted in 16% of cases, and in the presence of cardiovascular diseases increases to 26%. Clinical research data convincingly show that CKD is an independent risk factor for the development of VTE complications. The last decade has given us the opportunity to observe a kind of "revolution" in VTE therapy, which is associated with the appearance on the market of direct oral anticoagulants, including inhibitors of factor IIa (thrombin) and factor Xa. These drugs are approved by the Food and Drug Administration for the treatment of acute thromboembolism. Nevertheless, patients with severe CKD (estimated glomerular filtration rate <30 ml/min) are still limited to the use of unfractionated heparin and vitamin K antagonists, as there is insufficient data to support the use of direct oral anticoagulants in this population.

Keywords: chronic kidney disease, venous thromboembolic complications, anticoagulant therapy, direct acting anticoagulants

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22. Mahmoodi BK, Gansevoort RT, Veeger NJ, et al. Microalbuminuria and risk of venous thromboembolism. JAMA. 2009;301(17):1790-7. DOI:10.1001/jama.2009.565
23. Van Schouwenburg IM, Mahmoodi BK, Veeger NJ, et al. Elevated albuminuria associated with increased risk of recurrent venous thromboembolism: results of a population-based cohort study. Br J Haematol. 2012;156(5):667-71. DOI:10.1111/j.1365-2141.2011.09018.x
24. Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl.):e691S-736S. DOI:10.1378/chest.11-2300
25. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl.):160S-98S. DOI:10.1378/chest.08-0670
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________________________________________________

1. Khronicheskaia bolezn' pochek. Klinicheskie rekomendatsii. Assotsiatsiia nefrologov RF. 2021; s. 12-7 (in Russian).
2. Kidney Disease: Improving Global Outcomes (KDIGO) CKD Work Group. KDIGO 2012 Clinical Practice Guideline for the Evaluation and Management of Chronic Kidney Disease. Kidney Int Suppl. 2013;3:1-150. DOI:10.1038/kisup.2012.37
3. See EJ, Jayasinghe K, Glassford N, et al. Long-term risk of adverse outcomes after acute kidney injury: a systematic review and meta-analysis of cohort studies using consensus definitions of exposure. Kidney Int. 2019;95(1):160-72. DOI:10.1016/j.kint.2018.08.036
4. Bikbov BT, Tomilina NA. The state of substitution therapy in patients with chronic renal insufficiency in the Russian Federation in 1998–2007 (Analytical report according to the Russian Register of Renal Replacement Therapy). Nefrologiia i dializ. 2009;11(3):144-233 (in Russian).
5. Tomilina NA, Andrusev AM, Peregudova NG, Shinkarev MB. Replacement therapy of terminal chronic renal failure. Report on the data of the All-Russian Register of Renal Replacement Therapy of the Russian Dialysis Society. Part one. Nefrologiia i dializ. 2017;19(4 Suppl.):1-95 (in Russian). DOI:10.28996/1680-4422-2017-4suppl-1-9
6. Zoungas S, Arima H, Gerstein HC, et al. Effects of intensive glucose control on microvascular outcomes in patients with type 2 diabetes: a meta-analysis of individual participant data from randomised controlled trials. Lancet Diabetes Endocrinol. 2017;5(6):431-7. DOI:10.1016/S2213-8587(17)30104-3
7. Major RW, Cheng MRI, Grant RA, et al. Cardiovascular disease risk factors in chronic kidney disease: A systematic review and meta-analysis. PLoS One. 2018;13(3):e0192895. DOI:10.1371/journal.pone.0192895
8. Wattanakit K, Cushman M. Chronic kidney disease and venous thromboembolism: epidemiology and mechanisms. Curr Opin Pulm Med. 2009;15(5):408-12. DOI:10.1097/MCP.0b013e32832ee371
9. Heit JA, Spencer FA, White RH. The epidemiology of venous thromboembolism. J Thromb Thrombolysis. 2016;41(1):3-14. DOI:10.1007/s11239-015-1311-6
10. Centers for Disease Control and Prevention. Chronic kidney disease surveillance system – United States. 2014.
11. Heit JA. Epidemiology of venous thromboembolism. Nat Rev Cardiol. 2015;12(8):464-74. DOI:10.1038/nrcardio.2015.83
12. Christiansen CF, Schmidt M, Lamberg AL, et al. Kidney disease and risk of venous thromboembolism: a nationwide population-based case-control study. J Thromb Haemost. 2014;12(9):1449-54. DOI:10.1111/jth.12652
13. Kumar G, Sakhuja A, Taneja A, et al. Pulmonary embolism in patients with CKD and ESRD. Clin J Am Soc Nephrol. 2012;7(10):1584-90. DOI:10.2215/CJN.00250112
14. Deyo RA, Cherkin DC, Ciol MA. Adapting a clinical comorbidity index for use with ICD-9-CM administrative databases. J Clin Epidemiol. 1992;45(6):613-9.
DOI:10.1016/0895-4356(92)90133-8
15. Kato S, Chernyavsky S, Tokita JE, et al. Relationship between proteinuria and venous thromboembolism. J Thromb Thrombolysis. 2010;30(3):281-5.
DOI:10.1007/s11239-010-0442-z
16. Cheung KL, Zakai NA, Folsom AR, et al. Measures of Kidney Disease and the Risk of Venous Thromboembolism in the REGARDS (Reasons for Geographic and Racial Differences in Stroke) Study. Am J Kidney Dis. 2017;70(2):182-90. DOI:10.1053/j.ajkd.2016.10.039
17. Keller C, Katz R, Cushman M, et al. Association of kidney function with inflammatory and procoagulant markers in a diverse cohort: a cross-sectional analysis from the Multi-Ethnic Study of Atherosclerosis (MESA). BMC Nephrol. 2008;9:9. DOI:10.1186/1471-2369-9-9
18. Lutz J, Menke J, Sollinger D, et al. Haemostasis in chronic kidney disease. Nephrol Dial Transplant. 2014;29(1):29-40. DOI:10.1093/ndt/gft209
19. Camaioni C, Gustapane M, Cialdella P, et al. Microparticles and microRNAs: new players in the complex field of coagulation. Intern Emerg Med. 2013;8(4):291-6.
DOI:10.1007/s11739-011-0705-5
20. Wattanakit K, Cushman M, Stehman-Breen C, et al. Chronic kidney disease increases risk for venous thromboembolism. J Am Soc Nephrol. 2008;19(1):135-40. DOI:10.1681/ASN.2007030308
21. Folsom AR, Lutsey PL, Astor BC, et al. Chronic kidney disease and venous thromboembolism: a prospective study. Nephrol Dial Transplant. 2010;25(10):3296-301. DOI:10.1093/ndt/gfq179
22. Mahmoodi BK, Gansevoort RT, Veeger NJ, et al. Microalbuminuria and risk of venous thromboembolism. JAMA. 2009;301(17):1790-7. DOI:10.1001/jama.2009.565
23. Van Schouwenburg IM, Mahmoodi BK, Veeger NJ, et al. Elevated albuminuria associated with increased risk of recurrent venous thromboembolism: results of a population-based cohort study. Br J Haematol. 2012;156(5):667-71. DOI:10.1111/j.1365-2141.2011.09018.x
24. Bates SM, Greer IA, Middeldorp S, et al. VTE, thrombophilia, antithrombotic therapy, and pregnancy: Antithrombotic therapy and prevention of thrombosis, 9th ed: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines. Chest. 2012;141(2 Suppl.):e691S-736S. DOI:10.1378/chest.11-2300
25. Ansell J, Hirsh J, Hylek E, et al. Pharmacology and management of the vitamin K antagonists: American College of Chest Physicians Evidence-Based Clinical Practice Guidelines (8th Edition). Chest. 2008;133(6 Suppl.):160S-98S. DOI:10.1378/chest.08-0670
26. Agnelli G, Buller HR, Cohen A, et al. Oral apixaban for the treatment of acute venous thromboembolism. N Engl J Med. 2013;369(9):799-808. DOI:10.1056/NEJMoa1302507
27. EINSTEIN Investigators, Bauersachs R, Berkowitz SD, Brenner B, et al. Oral rivaroxaban for symptomatic venous thromboembolism. N Engl J Med. 2010;363(26):2499-510. DOI:10.1056/NEJMoa1007903
28. Hokusai-VTEI Investigators; Büller HR, Décousus H, Grosso MA, et al. Edoxaban versus warfarin for the treatment of symptomatic venous thromboembolism. N Engl J Med. 2013;369(15):1406-15. DOI:10.1056/NEJMoa1306638
29. Schulman S, Kearon C, Kakkar AK, et al. Dabigatran versus warfarin in the treatment of acute venous thromboembolism. N Engl J Med. 2009;361(24):2342-52. DOI:10.1056/NEJMoa0906598
30. Kearon C, Akl EA, Ornelas J, et al. Antithrombotic therapy for VTE disease: CHEST guideline and expert panel report. Chest. 2016;149(2):315-52. DOI:10.1016/j.chest.2015.11.026
31. Phillippe HM, Wright BM, Bowerman KE, et al. Pharmacist interventions regarding the appropriateness of apixaban, rivaroxaban, dabigatran, and warfarin in a university-affiliated outpatient clinic. J Pharm Technol. 2016;32(6):245-52. DOI:10.1177/8755122516672693
32. Alhousani M, Malik SU, Abu-Hashyeh A. Using oral anticoagulants among chronic kidney disease patients to prevent recurrent venous thromboembolism: A systematic review and meta-analysis. Thromb Res. 2021;198:103-14. DOI:10.1016/j.thromres.2020.11.036
33. Vílchez JA, Gallego P, Lip GY. Safety of new oral anticoagulant drugs: a perspective. Ther Adv Drug Saf. 2014;5(1):8-20. DOI:10.1177/2042098613507945
34. Schafer JH, Casey AL, Dupre KA, Staubes BA. Safety and Efficacy of Apixaban Versus Warfarin in Patients With Advanced Chronic Kidney Disease. Ann Pharmacother. 2018;52(11):1078-84. DOI:10.1177/1060028018781853
35. Cohen AT, Sah J, Dhamane AD, et al. Effectiveness and Safety of Apixaban versus Warfarin in Venous Thromboembolism Patients with Chronic Kidney Disease. Thromb Haemost. 2021. DOI:10.1055/s-0041-1740254
36. Fibrilliatsiia i trepetanie predserdii. Klinicheskie rekomendatsii. Rossiiskoe kardiologicheskoe obshchestvo. 2021; s. 78-9 (in Russian).

Авторы

О.Н. Джиоева*1,2, А.А. Орлова1, Е.А. Рогожкина1, О.М. Драпкина1,2

1 ФГБУ «Национальный медицинский исследовательский центр терапии и профилактической медицины» Минздрава России, Москва, Россия;
2 ФГБОУ ВО «Московский государственный медико-стоматологический университет им. А.И. Евдокимова» Минздрава России, Москва, Россия
*dzhioevaon@gmail.com

________________________________________________

Olga N. Dzhioeva*1,2, Anna A. Orlova1, Elizaveta A. Rogozhkina1, Oksana M. Drapkina1,2

1 National Research Center for Therapy and Preventive Medicine, Moscow, Russia;
2 Yevdokimov Moscow State University of Medicine and Dentistry, Moscow, Russia
*dzhioevaon@gmail.com

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