Plasma fibrinogen associates independently with total and cardiovascular mortality among subjects with normal and reduced kidney function in the general population
Stack, A. G.
Abdalla, A. A.
Casserly, L. F.
Cronin, C. J.
Nguyen, H. T.
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Stack, A. G. Donigiewicz, U.; Abdalla, A. A.; Weiland, A.; Casserly, L. F.; Cronin, C. J.; Nguyen, H. T.; Hannigan, A. (2014). Plasma fibrinogen associates independently with total and cardiovascular mortality among subjects with normal and reduced kidney function in the general population. QJM 107 (9), 701-713
Background: The contribution of novel risk factors to mortality in chronic kidney disease remains controversial. Aim: To explore the association of plasma fibrinogen with mortality among individuals with normal and reduced kidney function. Methods: We identified 9184 subjects, age 40 and over from the Third National Health and Nutrition Examination Survey (1988-94) with vital status assessed through 2006. Plasma fibrinogen was modeled as continuous variable and in quartile groups (0 to &lt;7.7, 7.7 to &lt;9.0, 9.0 to &lt;10.5 and 510.5 &gt;= mu mol/l) with total and cardiovascular mortality across categories of glomerular filtration rate (eGFR); &lt;60, 60-90, &gt;90 ml/min/1.73m(2) using Cox regression. Results: In multivariate analysis, the adjusted hazard ratio (HR) per 1 mu mol/l (34 mg/dl) increase in fibrinogen was 1.07 [95% confidence interval (CI) 1.04-1.09] for total mortality and 1.06 (95% CI 1.03-1.09) for cardiovascular mortality. The adjusted HR for total mortality was 1.05 (1.01-1.09) for subjects with eGFR 60-90 ml/min/1.73m(2) and 1.06 (1.02-1.10) for subjects with eGFR &lt;60 ml/min/1.73m(2). Subjects in the highest quartiles within each eGFR category; &gt;90, 60-90 and &lt;60 ml/min/1.73m(2) experienced HRs of 1.45 (95% CI 1.03-2.03), 1.35 (95% CI 1.00-1.83) and 1.72 (95% CI 1.14-2.58), respectively, compared with subjects in the lowest quartile group. The patterns were similar for cardiovascular mortality. Conclusions: Plasma fibrinogen associates with mortality among subjects with mild to moderate kidney impairment as it does in subjects with normal kidney function and should be considered a therapeutic target for cardiovascular risk reduction.