Abstract
BackgroundPlasma fibrinogen is significantly associated with cardiovascular (CV) events and mortality in the general population. However, the association between plasma fibrinogen and mortality in patients undergoing peritoneal dialysis (PD) is unclear.MethodsThis was a prospective cohort study. A total of 1603 incident PD patients from a single center in South China were followed for a median of 46.7 months. A Cox regression analysis was used to evaluate the independent association of plasma fibrinogen with CV and all-cause mortality. Models were adjusted for age, sex, smoking, a history of CV events, diabetes, body mass index, systolic blood pressure, hemoglobin, blood platelet count, serum potassium, serum albumin, low-density lipoprotein cholesterol, high-density lipoprotein cholesterol, hypersensitive C-reactive protein, estimated glomerular filtration rate, antiplatelet agents and lipid-lowering drugs.ResultsThe mean age was 47.4 ± 15.3 years, 955 (59.6%) patients were male, 319 (19.9%) had a history of CV events, and 410 (25.6%) had diabetes. The average plasma fibrinogen level was 4.12 ± 1.38 g/L. Of the 474 (29.6%) patients who died during follow-up, 235 (49.6%) died due to CV events. In multivariable models, the adjusted hazard ratios (HRs) for quartile 1, quartile 3, and quartile 4 versus quartile 2 were 1.18 (95% confidence interval [CI], 0.72–1.95, P = 0.51), 1.47 (95% CI, 0.93–2.33, P = 0.10), and 1.78 (95% CI, 1.15–2.77, P = 0.01) for CV mortality and 1.20 (95% CI, 0.86–1.68, P = 0.28), 1.29 (95% CI, 0.93–1.78, P = 0.13), and 1.53 (95% CI, 1.12–2.09, P = 0.007) for all-cause mortality, respectively. A nonlinear relationship between plasma fibrinogen and CV and all-cause mortality was observed.ConclusionsAn elevated plasma fibrinogen level was significantly associated with an increased risk of CV and all-cause mortality in patients undergoing PD.
Highlights
Plasma fibrinogen is significantly associated with cardiovascular (CV) events and mortality in the general population
In this study, an elevated plasma fibrinogen level was significantly associated with an increased risk of CV and all-cause mortality in patients undergoing peritoneal dialysis (PD), and the relationship between plasma fibrinogen and mortality was nonlinear
Our study found that high plasma fibrinogen levels were significantly associated with CV and all-cause mortality, which is consistent with some studies conducted on stage 3–4 chronic kidney disease (CKD) and HD patients [14, 16]
Summary
Plasma fibrinogen is significantly associated with cardiovascular (CV) events and mortality in the general population. The association between plasma fibrinogen and mortality in patients undergoing peritoneal dialysis (PD) is unclear. Patients with end-stage renal disease (ESRD) exhibit a high risk for cardiovascular (CV) event morbidity and mortality [1]. Plasma fibrinogen plays an important role in the coagulation cascade; levels that are too high or too low may cause an increased risk of thrombosis and bleeding, respectively. Studies have shown that the fibrinogen level is influenced by some traditional CV risk factors, such as age, smoking, diabetes, and hypertension, as well as emerging risk factors, such as inflammation [6, 7]. Fibrinogen may represent a risk factor [8] and provide a common pathway for the interaction of various risk factors promoting CV events
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