Serum fibrinogen levels are an independent predictor of mortality in patients with chronic kidney disease stages 3 and 4

Patients with chronic kidney disease have substantial risk for cardiovascular mortality, but the relative importance of traditional and novel risk factors is unknown. Several studies in hemodialysis patients have demonstrated that inflammatory markers are potent predictors of mortality, however there are scarce data about stable patients with moderate chronic kidney disease. 128 outpatients with estimated glomerular filtration of less than 60 ml/min per 1.73 m(2) were included in the study. Medical records about cardiovascular factors were recorded. Analytical parameters and inflammation markers were determined in baseline period. Participants were initially recruited from January 2002 to May 2002. The average length of follow-up in this longitudinal study was 5.5 years. Mortality and non-fatal cardiovascular events were the end points. Median follow-up was 67.8 months, all cause of mortality was 22.7%/(n = 29) and non-fatal cardiovascular events were 39.1% (n = 50). In multivariate analysis adjusting for demographic, cardiovascular and kidney disease factors, age hazard ratio (HR): 1.01, interval confidence (IC): 1.00-1.10), previous congestive heart failure (HR: 3.50, IC: 1.10-11.17) and both high CRP (HR: 3.48, IC: 1.53-7.59) and serum fibrinogen (HR: 1.45, IC: 1.04-1.50) were independent predictors of all-cause of mortality. Age (HR: 1.06, IC: 1.01-1.11), high CRP (HR: 2.80, IC: 1.60-4.90), cardiac troponin T (HR: 1.21, IC: 1.04-1.40) and previous coronary disease (HR: 2.67, IC: 1.28-5.54) but not serum fibrinogen were independent predictors of non-fatal cardiovascular events. Both high CRP and high serum fibrinogen levels and previous congestive heart failure measured in CKD stages 3 and 4, are independent risk factors for all-cause of mortality. High CRP but not high serum fibrinogen is a risk factor for non-fatal cardiovascular events. These results suggest that high CRP and high serum fibrinogen provide prognostic information in CKD patients.