Fibrinogen, mortality and incident cardiovascular complications in end-stage renal failure
Version of Record online: 9 JUL 2003
Journal of Internal Medicine
Volume 254, Issue 2, pages 132–139, August 2003
How to Cite
Zoccali, C., Mallamaci, F., Tripepi, G., Cutrupi, S., Parlongo, S., Malatino, L. S., Bonanno, G., Rapisarda, F., Fatuzzo, P., Seminara, G., Stancanelli, B., Nicocia, G. and Buemi, M. (2003), Fibrinogen, mortality and incident cardiovascular complications in end-stage renal failure. Journal of Internal Medicine, 254: 132–139. doi: 10.1046/j.1365-2796.2003.01180.x
- Issue online: 9 JUL 2003
- Version of Record online: 9 JUL 2003
- Received 13 January 2003; revision received 25 March 2003; accepted 1 April 2003.
- C-reactive protein;
- cardiovascular risk;
Abstract. Zoccali C, Mallamaci F, Tripepi G, Cutrupi S, Parlongo S, Malatino LS, Bonanno G, Rapisarda F, Fatuzzo P, Seminara G, Stancanelli B, Nicocia G, Buemi M (Institute of Biomedicine, Clinical Epidemiology and Pathophysiology of Renal Diseases and Hypertension, Reggio Cal; University of Catania; and University of Messina, Italy). Fibrinogen, mortality and incident cardiovascular complications in end-stage renal failure. J Intern Med 2003; 254: 132–139.
Objective. Fibrinogen is an established predictor of cardiovascular events in the general population but the relationship between fibrinogen, mortality and incident cardiovascular complications has been very little investigated in patients with end-stage renal disease (ESRD).
Design and subjects. We investigated the relationship between fibrinogen and all cause mortality and cardiovascular outcomes in a prospective cohort study in 192 patients on chronic haemodialysis treatment (follow-up: 34 ± 16 months).
Results. Fibrinogen was significantly higher in patients who died during the follow-up than in those who survived. Similarly, fibrinogen was higher in patients who had fatal or nonfatal cardiovascular events than in event free patients. On multivariate Cox regression analysis fibrinogen was an independent predictor of survival [hazard ratio (1 g L−1 increase in plasma fibrinogen): 1.19, 95% confidence interval (CI): 1.05–1.35, P = 0.006] and a highly significant (P = 0.0008), independent predictor of fatal and nonfatal cardiovascular events [hazard ratio (1 g L−1 increase in plasma fibrinogen): 1.25, 95% CI: 1.10–1.43] in a model including traditional risk factors and serum C-reactive protein (CRP) and plasma homocysteine.
Conclusions. Fibrinogen is as an independent risk factor for overall and cardiovascular mortality in patients with ESRD. Intervention studies are required to see whether reducing plasma fibrinogen may help to curb the exceedingly high cardiovascular risk of the uremic population.