Increased Fibrinogen Levels and Hemostatic Abnormalities in Patients with Arteriolar Nephrosclerosis: Association with Cardiovascular Events

SummaryIncreased plasma fibrinogen levels and hemostatic abnormalities suggestive of a prothrombotic state are present in patients with endstage renal failure and could contribute to increased cardiovascular morbidity in these patients. We investigated the relationship between abnormalities of the hemostatic system and the degree of renal failure and whether these abnormalities are associated with increased prevalence of cardiovascular events in patients with arteriolar nephrosclerosis. In 425 patients recruited at a hypertension clinic we assessed the renal function by creatinine clearance, urinary protein excretion, and microalbuminuria, the prevalence of atherosclerotic disease, and measured prothrombin time, activated partial thromboplastin time, fibrinogen, prothrombin fragment 1+2 (F1+2), D-dimer, and antithrombin. Early impairment of renal function (creatinine clearance, 30 to 89 ml/min per 1.73 m2 of body surface area) caused by arteriolar nephrosclerosis was found in 172 patients. Patients with early renal failure were significanly older and had significantly greater values of blood pressure, plasma fibrinogen, F1+2, and D-dimer than patients with normal renal function. Elevated D-dimer and fibrinogen levels were independently associated with the presence of decreased creatinine clearance. Log fibrinogen, log F1+2, and log D-dimer were inversely correlated with creatinine clearance. The prevalence of coronary artery, cerebrovascular, and peripheral vascular disease was significantly greater in patients with mild renal failure than in those with normal renal function. Elevated levels of fibrinogen and D-dimer were associated with the presence of atherosclerotic disease independent of renal function and other risk factors. In conclusion, changes in hemostatic parameters occur early in the course of renal failure in patients with arteriolar nephrosclerosis, suggesting a prothrombotic state that may contribute to the risk for atherosclerotic disease at all levels of renal function.

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Predictors of Postoperative Acute Renal Failure after Noncardiac Surgery in Patients with Previously Normal Renal Function

Anesthesiology ◽

10.1097/01.anes.0000290588.29668.38 ◽

2007 ◽

Vol 107 (6) ◽

pp. 892-902 ◽

Cited By ~ 323

Author(s):

Sachin Kheterpal ◽

Kevin K. Tremper ◽

Michael J. Englesbe ◽

Michael O’Reilly ◽

Amy M. Shanks ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Creatinine Clearance ◽

Normal Renal Function ◽

Noncardiac Surgery ◽

Intraoperative Management ◽

All Cause Mortality ◽

Calculated Creatinine Clearance ◽

Preoperative Predictors

Background The authors investigated the incidence and risk factors for postoperative acute renal failure after major noncardiac surgery among patients with previously normal renal function. Methods Adult patients undergoing major noncardiac surgery with a preoperative calculated creatinine clearance of 80 ml/min or greater were included in a prospective, observational study at a single tertiary care university hospital. Patients were followed for the development of acute renal failure (defined as a calculated creatinine clearance of 50 ml/min or less) within the first 7 postoperative days. Patient preoperative characteristics and intraoperative anesthetic management were evaluated for associations with acute renal failure. Thirty-day, 60-day, and 1-yr all-cause mortality was also evaluated. Results A total of 65,043 cases between 2003 and 2006 were reviewed. Of these, 15,102 patients met the inclusion criteria; 121 patients developed acute renal failure (0.8%), and 14 required renal replacement therapy (0.1%). Seven independent preoperative predictors were identified (P < 0.05): age, emergent surgery, liver disease, body mass index, high-risk surgery, peripheral vascular occlusive disease, and chronic obstructive pulmonary disease necessitating chronic bronchodilator therapy. Several intraoperative management variables were independent predictors of acute renal failure: total vasopressor dose administered, use of a vasopressor infusion, and diuretic administration. Acute renal failure was associated with increased 30-day, 60-day, and 1-yr all-cause mortality. Conclusions Several preoperative predictors previously reported to be associated with acute renal failure after cardiac surgery were also found to be associated with acute renal failure after noncardiac surgery. The use of vasopressor and diuretics is also associated with acute renal failure.

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Plasma D Dimer: A Useful Marker of Fibrin Breakdown in Renal Failure

Thrombosis and Haemostasis ◽

10.1055/s-0038-1646627 ◽

1989 ◽

Vol 61 (03) ◽

pp. 522-525 ◽

Cited By ~ 32

Author(s):

M P Gordge ◽

R W Faint ◽

P B Rylance ◽

H Ireland ◽

D A Lane ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Monoclonal Antibodies ◽

Diabetic Nephropathy ◽

Renal Disease ◽

Plasma Concentrations ◽

Significant Negative Correlation ◽

Healthy Controls ◽

D Dimer

SummaryD dimer and other large fragments produced during the breakdown of crosslinked fibrin may be measured by enzyme immunoassay using monoclonal antibodies. In 91 patients with renal disease and varying degrees of renal dysfunction, plasma D dimer showed no correlation with renal function, whereas FgE antigen, a fibrinogen derivative which is known to be cleared in part by the kidney, showed a significant negative correlation with creatinine clearance. Plasma concentrations of D dimer were, however, increased in patients with chronic renal failure (244 ± 3l ng/ml) (mean ± SEM) and diabetic nephropathy (308 ± 74 ng/ml), when compared with healthy controls (96 ± 13 ng/ml), and grossly elevated in patients with acute renal failure (2,451 ± 1,007 ng/ml). The results indicate an increase in fibrin formation and lysis, and not simply reduced elimination of D dimer by the kidneys, and are further evidence of activated coagulation in renal disease. D dimer appears to be a useful marker of fibrin breakdown in renal failure.

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Faculty Opinions recommendation of Predictors of postoperative acute renal failure after noncardiac surgery in patients with previously normal renal function.

Faculty Opinions – Post-Publication Peer Review of the Biomedical Literature ◽

10.3410/f.1099139.555351 ◽

2008 ◽

Author(s):

Lee Fleisher ◽

Michael Banks

Keyword(s):

Renal Failure ◽

Renal Function ◽

Acute Renal Failure ◽

Normal Renal Function ◽

Noncardiac Surgery

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Periodontal disease characterization in dogs with normal renal function or chronic renal failure

Ciência Rural ◽

10.1590/s0103-84782004000100017 ◽

2004 ◽

Vol 34 (1) ◽

pp. 113-118 ◽

Cited By ~ 1

Author(s):

Glenda Ramalho Barbudo-Selmi ◽

Marileda Bonafim Carvalho ◽

André Luis Selmi ◽

Silvio Emílio Cuevas Martins

Keyword(s):

Renal Failure ◽

Renal Function ◽

Chronic Renal Failure ◽

Periodontal Disease ◽

Normal Renal Function ◽

White Blood Cells ◽

Gingival Recession ◽

Plaque Index ◽

Urine Specific Gravity ◽

Bacterial Plaque

The purpose of this study was to evaluate periodontal disease (PD) in dogs with chronic renal failure (CRF) and to compare it to PD in dogs with normal renal function (NRF). Twelve dogs with CRF and 24 dogs with NRF, all presenting dental pocket formation, were compared. In all dogs, serum creatinine, blood urea nitrogen, urine specific gravity and total red and white blood cells were determined. A complete oral examination was also performed including evaluation of bacterial plaque, gingivitis, gingival recession, pocket, calculus, dental mobility, dental loss, and ulcers. These data were used to calculate plaque index (PI), gingival index (GI) and periodontal destruction index (PDI). PD was graded as mild, moderate or severe based on the results. Mild, moderate or severe PD was observed in dogs with NRF, whereas dogs with CRF presented either mild or severe PD. Dogs with NRF showed higher involvement of the maxillary teeth, whereas dogs with CRF showed a higher involvement of the mandibular teeth. Plaque index was significantly higher in dogs with NRF. It was concluded that lesion distribution and periodontal disease progression may be altered in dogs with CRF, and gingival inflammatory response differs in dogs with NRF and CRF regarding to the stage of periodontal disease.

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Characteristics of neuromuscular block after administration of rocuronium bromide in patients with end-stage renal failure

Srpski arhiv za celokupno lekarstvo ◽

10.2298/sarh1112765k ◽

2011 ◽

Vol 139 (11-12) ◽

pp. 765-771

Author(s):

Nevena Kalezic ◽

Biljana Krivic ◽

Vladan Zivaljevic ◽

Djordje Ugrinovic ◽

Dijana Jovanovic ◽

...

Keyword(s):

Renal Failure ◽

Renal Function ◽

Normal Renal Function ◽

Neuromuscular Block ◽

Onset Time ◽

Cumulative Effect ◽

Control Group ◽

Rocuronium Bromide ◽

Duration Time ◽

Development Duration

Introduction. Anaesthesia affects kidney function by reducing the renal blood flow and glomerular filtration rate. As chronic renal failure (CRF) significantly influences drug metabolism and elimination, we studied the effects of rocuronium bromide (RB) in patients with CRF. Objective. The aim of the study was to examine whether, when using RB in patients with CFR, there are differences regarding the onset time of neuromuscular block (NMB) development, duration time, speed of recovery and cumulative effects of RB. Methods. Prospective study included 60 patients who underwent urologic surgery procedures. The patients were divided into 3 groups: the first group (G1) - 20 patients with CRF and residual dieresis, the second group (G2) - 20 patients with CRF and without dieresis, and third group (G3) - 20 patients with normal renal function (control group). During surgery RB was administrated for muscle paralysis in all patients. Train-of-four (TOF) Guard acceleromyography was used for NMB monitoring. Results. Onset time in three groups was 132.3 s; 139.5 s and 113.2 s (r<0.01). Duration of intubation dose was the same in G1 and G2 (28.9 minutes), while in the third group it was 27.2 minutes (r>0.05). The number of RB repeated doses was 3-8, 3-7 and 4-8 (r>0.05). The duration time until spontaneous recovery was 31.8, 31.6 and 29.8 minutes (r>0.01). The recovery index was 16.8, 16.7 and 10.6 minutes (r<0.001). The duration time from the last dose of RB to extubation was 74.5, 74.8 and 58.9 minutes (r<0.001). Conclusion. In patients with CRF the cumulative effect of the drug was registered, with a prolonged recovery time from NMB in relation to the patients with normal renal function.

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1062-42 Adverse events in patients with normal renal function are increased with modest increases in creatinine clearance after percutaneous coronary intervention

Journal of the American College of Cardiology ◽

10.1016/s0735-1097(04)90200-8 ◽

2004 ◽

Vol 43 (5) ◽

pp. A47-A48

Author(s):

Beth A Bartholomew ◽

Cindy L Grines ◽

Judith A Boura ◽

William W O'Neill

Keyword(s):

Percutaneous Coronary Intervention ◽

Renal Function ◽

Adverse Events ◽

Creatinine Clearance ◽

Normal Renal Function ◽

Coronary Intervention ◽

Percutaneous Coronary

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Dosage Regimen Adjustments in Renal Impairment

Drug Intelligence & Clinical Pharmacy ◽

10.1177/106002807300700902 ◽

1973 ◽

Vol 7 (9) ◽

pp. 382-387 ◽

Cited By ~ 29

Author(s):

Donald L. Giusti ◽

William L. Hayton

Keyword(s):

Renal Failure ◽

Renal Function ◽

Renal Impairment ◽

Creatinine Clearance ◽

Dosage Regimen ◽

Drug Dosage ◽

Loading Dose ◽

Dosage Regimens ◽

Drug Dosage Regimen ◽

Pharmacokinetic Approach

A pharmacokinetic approach based on creatinine clearance has been outlined which permits drug dosage regimen adjustments in patients with renal impairment. The parameters needed for calculating a loading dose and a maintenance regimen are the fraction of a dose excreted unchanged in the urine, the creatinine clearance of the patient, and the half-life of the drug in patients with normal renal function. In varying degrees of renal failure, predicted dosage regimens agree closely with dosage regimens predicted by other methods for a number of drugs.

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Phosphorous and Risk of Renal Failure in Subjects with Normal Renal Function

Journal of Emergency Medicine ◽

10.1016/j.jemermed.2013.05.035 ◽

2013 ◽

Vol 45 (1) ◽

pp. 152

Author(s):

Jordan Ryan

Keyword(s):

Renal Failure ◽

Renal Function ◽

Normal Renal Function

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Serum Concentration of Growth Differentiation Factor-15 Is Independently Associated with Global Platelet Function and Higher Fibrinogen Values in Adult Healthy Subjects

Seminars in Thrombosis and Hemostasis ◽

10.1055/s-0037-1603358 ◽

2017 ◽

Vol 43 (06) ◽

pp. 621-628 ◽

Cited By ~ 1

Author(s):

Gian Salvagno ◽

Elisa Danese ◽

Giorgio Brocco ◽

Matteo Gelati ◽

Martina Montagnana ◽

...

Keyword(s):

Renal Function ◽

Serum Concentration ◽

Platelet Function ◽

Healthy Subjects ◽

Cardiovascular Events ◽

Linear Regression Analysis ◽

Univariate Analysis ◽

Plasma Fibrinogen ◽

Growth Differentiation Factor 15 ◽

Differentiation Factor

AbstractGrowth differentiation factor-15 (GDF-15) has recently emerged as a strong and independent predictor of cardiovascular events and mortality. However, the pathophysiological mechanisms underlying this important association remain speculative. This study was aimed to investigate the potential associations between the serum concentration of GDF-15 and clinical or laboratory parameters in a population of ostensibly healthy subjects. The study population consisted of 44 healthy volunteers enrolled from the laboratory staff (14 males and 30 females; mean age, 47 ± 11 years), who had their blood collected for assessing complete blood cell count, GDF-15, serum creatinine, albumin, cardiac troponin T, galectin-3, routine coagulation tests, D-dimer, von Willebrand factor, and platelet function testing using platelet function analyzer-100. In univariate analysis, serum GDF-15 was found to be positively associated with age and plasma fibrinogen, and negatively associated with renal function and collagen-epinephrine (CEPI). In multiple linear regression analysis, serum GDF-15 remained significantly associated with renal function, CEPI, and plasma fibrinogen. Healthy subjects with GDF-15 above the median value had a twofold probability of displaying shorter CEPI closure times. Taken together, these results suggest that higher serum values of GDF-15 may be associated with overall global platelet hyperactivity and increased plasma fibrinogen, so providing another plausible explanation for the association between GDF-15, cardiovascular events, and mortality.

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