title: Plasma fibrinogen associates independently with total and cardiovascular mortality among subjects with normal and reduced kidney function in the general population.
abstract: BACKGROUND
  The contribution of novel risk factors to mortality in chronic kidney disease remains controversial.
  
  
  OBJECTIVE
  To explore the association of plasma fibrinogen with mortality among individuals with normal and reduced kidney function.
  
  
  METHODS
  We identified 9184 subjects, age 40 and over from the Third National Health and Nutrition Examination Survey (1988-94) with vital status assessed through 2006. Plasma fibrinogen was modeled as continuous variable and in quartile groups (0 to <7.7, 7.7 to <9.0, 9.0 to <10.5 and ≥ 10.5 µmol/l) with total and cardiovascular mortality across categories of glomerular filtration rate (eGFR); <60, 60-90, >90 ml/min/1.73 m(2) using Cox regression.
  
  
  RESULTS
  In multivariate analysis, the adjusted hazard ratio (HR) per 1 µmol/l (34 mg/dl) increase in fibrinogen was 1.07 [95% confidence interval (CI) 1.04-1.09] for total mortality and 1.06 (95% CI 1.03-1.09) for cardiovascular mortality. The adjusted HR for total mortality was 1.05 (1.01-1.09) for subjects with eGFR 60-90 ml/min/1.73 m(2) and 1.06 (1.02-1.10) for subjects with eGFR <60 ml/min/1.73 m(2). Subjects in the highest quartiles within each eGFR category; >90, 60-90 and <60 ml/min/1.73 m(2) experienced HRs of 1.45 (95% CI 1.03-2.03), 1.35 (95% CI 1.00-1.83) and 1.72 (95% CI 1.14-2.58), respectively, compared with subjects in the lowest quartile group. The patterns were similar for cardiovascular mortality.
  
  
  CONCLUSIONS
  Plasma fibrinogen associates with mortality among subjects with mild to moderate kidney impairment as it does in subjects with normal kidney function and should be considered a therapeutic target for cardiovascular risk reduction.
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: A G
authors.initials: AG
authors.lastname: Stack
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: U
authors.initials: U
authors.lastname: Donigiewicz
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: A A
authors.initials: AA
authors.lastname: Abdalla
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Weiland
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: L F
authors.initials: LF
authors.lastname: Casserly
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: C J
authors.initials: CJ
authors.lastname: Cronin
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: H T
authors.initials: HT
authors.lastname: Nguyen
authors.affiliation: From the Division of Nephrology, Department of Medicine, University Hospital Limerick, Limerick, Graduate Entry Medical School, University of Limerick, Limerick and Department of Medicine, School of Medicine, National University of Ireland, Galway, Ireland.
authors.forename: A
authors.initials: A
authors.lastname: Hannigan
mesh_terms: D002318:Cardiovascular Diseases / Q000097:blood / Q000401:mortality; D002423:Cause of Death; D016001:Confidence Intervals; D005260:Female; D005340:Fibrinogen / Q000032:analysis*; D006801:Humans; D007494:Ireland / Q000453:epidemiology; D007677:Kidney Function Tests; D008297:Male; D008875:Middle Aged; D009026:Mortality; D009749:Nutrition Surveys; D016016:Proportional Hazards Models; D051436:Renal Insufficiency, Chronic / Q000097:blood / Q000175:diagnosis / Q000453:epidemiology; D012307:Risk Factors; D012720:Severity of Illness Index
chemical_list: D005340:Fibrinogen