on December 2, 2002
Circulation. 2002
Published online before print December 2, 2002, doi: 10.1161/01.CIR.0000042700.48769.59
Published online before print December 2, 2002, doi: 10.1161/01.CIR.0000042700.48769.59
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Submitted on September 6, 2002
From the Departments of Medicine, Epidemiology, and Biostatistics, University of California, San Francisco, and the Veterans Affairs Medical Center, San Francisco (M.G.S.); Renal-Electrolyte Division, University of Pittsburgh School of Medicine, and the Renal Section, VA Pittsburgh Healthcare System (L.F.F.); Departments of Medicine (B.M.P.), Epidemiology (B.M.P., C.C.), and Health Services (B.M.P.), University of Washington, Seattle; the Section of Nephrology (A.J.B.) and the Department of Public Health Sciences (C.D.F.), Wake Forest/Bowman Gray School of Medicine, Winston-Salem, NC; the Division of Epidemiology and Clinical Applications, National Heart, Lung, and Blood Institute, Bethesda, Md (T.A.M.); and the Departments of Pathology and Biochemistry, the University of Vermont College of Medicine, Burlington, Vt (R.P.T.). * To whom correspondence should be addressed. E-mail: shlip{at}itsa.ucsf.edu.
Background—Renal insufficiency has been associated with cardiovascular disease events and mortality in several prospective studies, but the mechanisms for the elevated risk are not clear. Little is known about the association of renal insufficiency with inflammatory and procoagulant markers, which are potential mediators for the cardiovascular risk of kidney disease. Methods and Results—The cross-sectional association of renal insufficiency with 8 inflammatory and procoagulant factors was evaluated using baseline data from the Cardiovascular Health Study, a population-based cohort study of 5888 subjects aged Conclusion—Renal insufficiency was independently associated with elevations in inflammatory and procoagulant biomarkers. These pathways may be important mediators leading to the increased cardiovascular risk of persons with kidney disease.
Accepted on September 27, 2002
Elevations of Inflammatory and Procoagulant Biomarkers in Elderly Persons With Renal Insufficiency
Michael G. Shlipak MD, MPH*,
65 years. C-reactive protein, fibrinogen, factor VIIc, and factor VIIIc levels were measured in nearly all participants; interleukin-6, intercellular adhesion molecule-1, plasmin-antiplasmin complex, and D-dimer levels were measured in nearly half of participants. Renal insufficiency was defined as a serum creatinine level 1.3 mg/dL in women and 1.5 mg/dL in men. Multivariate linear regression was used to compare adjusted mean levels of each biomarker in persons with and without renal insufficiency after adjustment for other baseline characteristics. Renal insufficiency was present in 647 (11%) of Cardiovascular Health Study participants. After adjustment for baseline differences, levels of C-reactive protein, fibrinogen, interleukin-6, factor VIIc, factor VIIIc, plasmin-antiplasmin complex, and D-dimer were significantly greater among persons with renal insufficiency (P<0.001). In participants with clinical, subclinical, and no cardiovascular disease at baseline, the positive associations of renal insufficiency with these inflammatory and procoagulant markers were similar.
Key words: inflammation • coagulation • kidney • coronary disease
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