Kidney function and multiple hemostatic markers: cross sectional associations in the multi-ethnic study of atherosclerosis

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Dubin, Ruth ; Cushman, Mary ; Folsom, Aaron R ; Fried, Linda F ; Palmas, Walter ; Peralta, Carmen A ; Wassel, Christina ; Shlipak, Michael G (2011)
  • Publisher: Springer Nature
  • Journal: BMC Nephrology, volume 12, pages 3-3 (issn: 1471-2369, eissn: 1471-2369)
  • Related identifiers: doi: 10.1186/1471-2369-12-3, pmc: PMC3037849
  • Subject: Nephrology | Diseases of the genitourinary system. Urology | RC870-923 | Research Article

<p>Abstract</p> <p>Background</p> <p>Defined as estimated glomerular filtration rate (eGFR) < 60 ml/min/1.73 m2, chronic kidney disease (CKD) is strongly and independently associated with cardiovascular and overall mortality. We hypothesized that reduced kidney function would be characterized by abnormalities of hemostasis.</p> <p>Methods</p> <p>We tested cross-sectional associations between (eGFR) and multiple hemostatic markers among 6751 participants representing a broad spectrum of kidney function in the Multi-Ethnic Study of Atherosclerosis (MESA). Kidney function was measured using cystatin C (eGFRcys) or creatinine, using CKD Epidemiology Collaboration (eGFRcr). Hemostatic markers included soluble thrombomodulin (sTM), soluble tissue factor (sTF), D-Dimer, von Willebrand factor (vWF), factor VIII, plasmin-antiplasmin complex (PAP), tissue factor pathway inhibitor (TFPI), plasminogen activator inhibitor-1 (PAI-1), and fibrinogen. Associations were tested using multivariable linear regression with adjustment for demographics and comorbidities.</p> <p>Results</p> <p>In comparison to persons with eGFRcys >90 ml/min/1.73 m<sup>2</sup>, subjects with eGFRcys < 60 ml/min/1.73 m<sup>2 </sup>had adjusted levels of sTM, sTF, D-Dimer, PAP, Factor VIII, TFPI, vWF and fibrinogen that were respectively 86%, 68%, 44%, 22%, 17%, 15%, 12% and 6% higher. Subjects with eGFRcys 60-90 ml/min/1.73 m<sup>2 </sup>had adjusted levels that were respectively 16%, 14%, 12%, 6%, 6%, 6%, 11% and 4% higher (p < 0.05 for all). Percent differences were not significantly different when groups were categorized by eGFRcr.</p> <p>Conclusions</p> <p>Throughout a broad spectrum of kidney function, lower eGFR was associated with higher levels of hemostatic markers. Dysregulation of hemostasis may be a mechanism by which reduced kidney function promotes higher cardiovascular risk.</p>
  • References (44)
    44 references, page 1 of 5

    1. KDOQI: Definition and Classification of Stages of Chronic Kidney Disease. 2002 [ p4_class_g2.htm].

    2. Coresh J, Astor B, Sarnak MJ: Evidence for increased cardiovascular disease risk in patients with chronic kidney disease. Curr Opin Nephrol Hypertens 2004, 13(1):73-81.

    3. Schiffrin EL, Lipman ML, Mann JF: Chronic kidney disease: effects on the cardiovascular system. Circulation 2007, 116(1):85-97.

    4. Shlipak MG, Katz R, Sarnak MJ, Fried LF, Newman AB, Stehman-Breen C, et al: Cystatin C and prognosis for cardiovascular and kidney outcomes in elderly persons without chronic kidney disease. Ann Intern Med 2006, 145(4):237-46.

    5. Shlipak MG, Sarnak MJ, Katz R, Fried LF, Seliger SL, Newman AB, et al: Cystatin C and the risk of death and cardiovascular events among elderly persons. N Engl J Med 2005, 352(20):2049-60.

    6. Shlipak MG, Wassel Fyr CL, Chertow GM, Harris TB, Kritchevsky SB, Tylavsky FA, et al: Cystatin C and mortality risk in the elderly: the health, aging, and body composition study. J Am Soc Nephrol 2006, 17(1):254-61.

    7. Stenvinkel P, Carrero JJ, Axelsson J, Lindholm B, Heimburger O, Massy Z: Emerging biomarkers for evaluating cardiovascular risk in the chronic kidney disease patient: how do new pieces fit into the uremic puzzle? Clin J Am Soc Nephrol 2008, 3(2):505-21.

    8. Cheung AK, Sarnak MJ, Yan G, Dwyer JT, Heyka RJ, Rocco MV, et al: Atherosclerotic cardiovascular disease risks in chronic hemodialysis patients. Kidney Int 2000, 58(1):353-62.

    9. Massy ZA, Taupin P, Jungers P, Landais P: Prediction model of coronary heart disease in patients with chronic kidney disease: role of plasma fibrinogen as a new prognostic variable. Prilozi 2005, 26(2):63-77.

    10. Spiegel DM, Raggi P, Smits G, Block GA: Factors associated with mortality in patients new to haemodialysis. Nephrol Dial Transplant 2007, 22(12):3568-72.

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