1. Reduced renal function strongly affects survival and thrombosis in patients with myelofibrosis
- Author
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Ivan Zekanović, Ivan Krečak, Martina Moric Peric, Hrvoje Holik, Vlatka Periša, Davor Galusic, Martina Sedinic, Tajana Štoos-Veić, Marko Lucijanic, and Rajko Kusec
- Subjects
JAK2 ,Myeloproliferative neoplasm ,Renal function ,Survival ,Thrombosis ,Male ,medicine.medical_specialty ,Primary Myelofibrosis / diagnosis ,Kidney ,Gastroenterology ,Renal Insufficiency, Chronic / diagnosis ,Thrombosis / mortality ,Cohort Studies ,Thrombosis / diagnosis ,03 medical and health sciences ,Renal Insufficiency, Chronic / mortality ,0302 clinical medicine ,Internal medicine ,medicine ,Humans ,Renal Insufficiency, Chronic ,Myelofibrosis ,Prospective cohort study ,Kidney / physiology ,Aged ,Retrospective Studies ,Primary Myelofibrosis / mortality ,business.industry ,Hematology ,General Medicine ,Middle Aged ,medicine.disease ,Survival Rate ,Primary Myelofibrosis / physiopathology ,Venous thrombosis ,Survival Rate / trends ,Primary Myelofibrosis ,030220 oncology & carcinogenesis ,Cohort ,Glomerular Filtration Rate / physiology ,Female ,Renal Insufficiency, Chronic / physiopathology ,business ,Thrombosis / physiopathology ,030215 immunology ,Kidney disease ,Glomerular Filtration Rate - Abstract
We retrospectively investigated a cohort of 176 myelofibrosis patients (128 primary-PMF ; 48 secondary-SMF) from five hematology centers. The presence of chronic kidney disease (CKD) was determined in addition to other clinical characteristics. CKD was present in 26.1% of MF patients and was significantly associated with older age (P < 0.001), higher WBC (P = 0.015), and its subsets (neutrophil, monocyte, and basophil counts), higher platelets (P = 0.001), lower albumin (P = 0.018), higher serum uric acid (P = 0.001), higher LDH (P = 0.022), and the presence of CV risk factors (P = 0.011). There was no significant association with driver mutations, degree of bone marrow fibrosis, PMF/SMF, or DIPSS risk categories (P > 0.05 for all analyses). The presence of CKD was significantly associated with shorter time to arterial (HR = 3.49 ; P = 0.041) and venous thrombosis (HR = 7.08 ; P = 0.030) as well as with shorter overall survival (HR 2.08 ; P = 0.009). In multivariate analyses, CKD (HR = 1.8 ; P = 0.014) was associated with shorter survival independently of the DIPSS (HR = 2.7 ; P < 0.001) ; its effect being more pronounced in lower (HR = 3.56 ; P = 0.036) than higher DIPSS categories (HR = 2.07 ; P = 0.023). MF patients with CKD should be candidates for active management aimed at the improvement of renal function. Prospective studies defining the optimal therapeutic approach are highly needed.
- Published
- 2020