Validity of plasma fibrinogen, D-dimer, and the von Willebrand factor as markers of cardiovascular morbidity in patients on chronic hemodialysis.
BACKGROUND
Among the non-classic cardiovascular disease risk factors in end-stage renal disease patients on chronic hemodialysis (HD), plasma fibrinogen, D-dimer, and von Willebrand factor (vWf) levels are potential markers of cardiovascular morbidity. We designed this case-control study to investigate their validity and any differences between them.


METHODS
Twenty-five HD patients (18 males, mean age: 63, range: 52-69 years) comprised the group with prevalent cardiovascular disease (CVD) and 50 HD patients (35 males, mean age: 62, range: 40-77 years) with non-evident cardiovascular disease history constituted the second study group. Twenty-five healthy non-smoking volunteers served as controls for comparison with the study groups.


RESULTS
Patients with CVD had significantly higher concentrations of plasma fibrinogen, D-dimer, and vWf than patients without incident CVD. All three parameters correlated positively with cardiovascular morbidity, i.e. fibrinogen (r=0.378, P<0.001), logDD (r=0.70, P<0.001), vWf (r=0.214, P<0.001), and logCRP (r=0.704, P<0.001). Among them, D-dimer exhibited the characteristics most coherent with CVD. The age- and sex-adjusted odds ratio (OR) of D-dimer for the presence of CVD was 2.0, which did not change appreciably when adjustments for several pathophysiological clusters of variables were made, except for a marginal reduction in OR following adjustment for markers of inflammation.


CONCLUSIONS
Among the coagulation molecules studied, plasma D-dimer levels exhibited the characteristics most coherent with associated CVD and were found to be strongly and independently associated with the prevalence of CVD in HD patients.
Kirmizis
Dimitrios
D
Department of Nephrology, Serres General Hospital, Serres, Greece. kirmizis@med.auth.gr
Tsiandoulas
Apostolos
A
Pangalou
Maria
M
Koutoupa
Evangelia
E
Rozi
Paraskevi
P
Protopappa
Maria
M
Barboutis
Konstantinos
K
D000328:Adult; D000368:Aged; D015415:Biomarkers / Q000097:blood; D002318:Cardiovascular Diseases / Q000097:blood* / Q000209:etiology; D016022:Case-Control Studies; D005260:Female; D005338:Fibrin Fibrinogen Degradation Products / Q000378:metabolism*; D005340:Fibrinogen / Q000378:metabolism*; D006801:Humans; D007676:Kidney Failure, Chronic / Q000097:blood / Q000150:complications / Q000628:therapy; D008297:Male; D008875:Middle Aged; D016017:Odds Ratio; D006435:Renal Dialysis; D015203:Reproducibility of Results; D014841:von Willebrand Factor / Q000378:metabolism*
D015415:Biomarkers; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D; D014841:von Willebrand Factor; D005340:Fibrinogen