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>
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