Validity of plasma fibrinogen, D-dimer, and the von Willebrand factor as markers of cardiovascular morbidity in patients on chronic hemodialysis.

BACKGROUND

Among the non-classic cardiovascular disease risk factors in end-stage renal disease patients on chronic hemodialysis (HD), plasma fibrinogen, D-dimer, and von Willebrand factor (vWf) levels are potential markers of cardiovascular morbidity. We designed this case-control study to investigate their validity and any differences between them.

MATERIAL/METHODS: Twenty-five HD patients (18 males, mean age: 63, range: 52-69 years) comprised the group with prevalent cardiovascular disease (CVD) and 50 HD patients (35 males, mean age: 62, range: 40-77 years) with non-evident cardiovascular disease history constituted the second study group. Twenty-five healthy non-smoking volunteers served as controls for comparison with the study groups.

RESULTS

Patients with CVD had significantly higher concentrations of plasma fibrinogen, D-dimer, and vWf than patients without incident CVD. All three parameters correlated positively with cardiovascular morbidity, i.e. fibrinogen (r=0.378, P<0.001), logDD (r=0.70, P<0.001), vWf (r=0.214, P<0.001), and logCRP (r=0.704, P<0.001). Among them, D-dimer exhibited the characteristics most coherent with CVD. The age- and sex-adjusted odds ratio (OR) of D-dimer for the presence of CVD was 2.0, which did not change appreciably when adjustments for several pathophysiological clusters of variables were made, except for a marginal reduction in OR following adjustment for markers of inflammation.

CONCLUSIONS

Among the coagulation molecules studied, plasma D-dimer levels exhibited the characteristics most coherent with associated CVD and were found to be strongly and independently associated with the prevalence of CVD in HD patients.