Nephrology Dialysis Transplantation, Vol 14, Issue 1 137-141, Copyright © 1999 by Oxford University Press
I Song, W Yang, S Kim, J Lee, T Kwon and J Park
Background: Elevated plasma fibrinogen is an important
risk factor for coronary artery disease in the general population and
patients with chronic renal failure. High plasma fibrinogen may trigger
thrombus formation in arteriovenous fistulas. We performed a prospective,
cohort study to evaluate the association of plasma fibrinogen concentration
with vascular access failure in patients undergoing long-term
haemodialysis. Methods: Between September 1989 and
October 1995, 144 patients underwent a vascular access operation. In March
1997, 102 patients 956 M, 46 F) who had been followed up for more than 18
months (median; 37 months, range; 18-102 months) were included in the
study. The median age of the patients was 52 years (range; 19-78 years). In
35 patients, renal disease was secondary to diabetes mellitus. The type of
vascular access was a polytetrafluoroethylene (PTFE) graft in 17 patients.
Seventy-seven patients received recombinant human erythropoietin (r-HuEPO)
therapy during the follow-up period. Plasma fibrinogen albumin total
cholesterol, hematocrit, platelets and creatinine were measured at the time
of operation. Vascular access failure was defined as the occurrence of
complications requiring transluminal angioplasty, thrombolytic therapy or
surgical repair. Results: thirty-eight patients had at
lest one vascular access failure and the incidence was 0.3 (range; 0-2.4)
episodes per patient-year. The survival rate of vascular access was 78%
(native fistula; 80%, PTFE graft; 71%) after 12 months and 70% (native
fistula; 73%, PTFE graft; 51%) after 24 months. Older age, a PTFE graft,
r-HuEPO therapy, higher hematocrit, lower albumin and higher fibrinogen
levels were significantly associated with vascular access failure, whereas
gender, diabetes mellitus, total cholesterol and platelet count were not.
Plasma fibrinogen was inversely correlated with albumin (r=-0.38, P-0.001).
The cumulative vascular access survival was significantly lower in patients
with high plasma fibrinogen levels (⩾460 mg/dl) compared with
patients with low levels (<460 mg/dl) (P=0.007). Independent risk
factors for vascular access failure analysed by Cox's proportional hazards
model were older age (RR; 1.36 by 10-year increment), higher fibrinogen
level (RR; 1.20 by 100 mg/dl increment), PTFE graft (RR; 2.28) and r-HuEPO
therapy (RR; 3.79). Conclusions: High plasma
fibrinogen level is an independent risk factor for vascular access failure
in haemodialysis patients. Key words: fibrinogen;
haemodialysis; risk factor; vascular access failure
ORIGINAL ARTICLES
Association of plasma fibrinogen concentration with vascular access failure in hemodialysis patients
Nephrology Section, Department of Medicine and Vascular Surgery, Asan Medical Center, College of Medicine, University of Ulsan, Song-Pa, PO Box 145, Seoul 128-040, Korea; Nephrology Section, Department of Medicine, Gil Medical Center, Gachon Medical College, Incon, Korea; Corresponding author
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