Risk factors for thromboembolic events in renal failure.
OBJECTIVE
To determine whether prior thromboembolic events (TE) influence current measures of hemostasis, inflammation and oxidative stress in a population at high cardiovascular risk.


BACKGROUND
Renal failure patients demonstrate a remarkably elevated incidence of TE.


METHODS
Relationships between plasma test results and prior TE history were studied in 78 diabetic and 23 non-diabetic patients with renal failure. TE were defined as myocardial infarction, stroke or vascular surgery.


RESULTS
Markers for inflammation (interleukin (IL)-6, C reactive protein (CRP)), thrombosis (fibrinogen, low molecular weight (LMW) fibrinogen, factor VII, viscosity), fibrinolysis (fibrinolytic activity, plasminogen activator inhibitor (PAI)), endothelial/platelet activity (P-selectin, von Willebrand factor (vWf)) and oxidative stress (antibody to oxidized low-density lipoprotein (LDL), advanced glycated end products) were significantly different from a healthy control population. Dialysis patients with diabetes were twice as likely to have sustained a TE (58 vs. 30%, p = 0.032). Those patients in the total group with levels above the median for IL-6 (p = 0.045), and CRP (p < 0.017) were more likely to have sustained a TE than those with levels below the median. Those diabetic patients with levels above the median for CRP were more likely to have a prior history of TE (p < 0.021). For non-diabetic patients, levels above the median of IL-6 were associated with a prior history of TE (p = 0.027). Multiple correlations for factors of inflammation, hemostasis and oxidative stress indicate that these mechanisms are not independent of one another.


CONCLUSIONS
Prior TE was associated with markers of inflammation a relationship that may influence the interpretation of these tests which are strongly interrelated in patients at high cardiovascular risk.
D'Elia
John A
JA
Joslin Diabetes Center, Boston, MA 02215, USA. lweinrauch@hms.harvard.edu
Weinrauch
Larry A
LA
Gleason
Ray E
RE
Lipinska
Izabela
I
Lipinski
Boguslaw
B
Lee
Annette T
AT
Tofler
Geoffrey H
GH
D000328:Adult; D015415:Biomarkers; D016022:Case-Control Studies; D003430:Cross-Sectional Studies; D048909:Diabetes Complications; D005260:Female; D006487:Hemostasis; D006801:Humans; D007249:Inflammation; D007676:Kidney Failure, Chronic / Q000150:complications*; D008297:Male; D008875:Middle Aged; D018384:Oxidative Stress; D012307:Risk Factors; D013923:Thromboembolism / Q000209:etiology*
D015415:Biomarkers