13 research outputs found
Abnormalities of coagulation in hypertensive patients with reduced creatinine clearance
PURPOSE: The prothrombotic state that occurs in uremic patients
may increase their cardiovascular risk. We studied hypertensive
patients with mild-to-moderate impairment of renal
function to determine if they had evidence of abnormalities in
the coagulation system.
SUBJECTS AND METHODS: Renal function was assessed in
382 patients with essential hypertension, in whom 24-hour creatinine
clearance, urinary protein excretion, and microalbuminuria
were measured. We evaluated the function of the coagulation
system by measurement of platelet counts, prothrombin
time, partial thromboplastin time, and plasma
antithrombin III, fibrinogen, D-dimer, and prothrombin fragment
1 1 2 levels.
RESULTS: Impaired renal function, defined as a creatinine
clearance of 30 to 89 mL per minute per 1.73m2 of body surface
area, was found in 168 (44%) of the patients. Age, blood pressure,
duration of hypertension, and plasma levels of fibrinogen,
D-dimer, prothrombin fragment 1 1 2, and lipoprotein(a)
were significantly greater in these patients than in those with
normal renal function; these differences persisted after adjustment
for potential confounders. Creatinine clearance was significantly
and inversely correlated with levels of plasma fibrinogen
(Spearman\u2019s rho 5 20.26, P ,0.001), D-dimer (rho 5
20.33, P ,0.001), and prothrombin fragment 1 1 2 (rho 5
20.20, P,0.001). Levels of plasma fibrinogen (P50.009) and
D-dimer (P 5 0.003) were correlated with renal function independent
of age, blood pressure, duration of hypertension, triglyceride
level, urinary protein excretion, and erythrocyte sedimentation
rate. Lipoprotein(a) levels were correlated with fibrinogen
(rho 5 0.16, P 5 0.003) and D-dimer (rho 5 0.26, P
,0.001) levels.
CONCLUSIONS: Increased plasma levels of fibrinogen,
D-dimer, and prothrombin fragment 1 1 2 are present in hypertensive
patients with mildly decreased creatinine clearance,
suggesting that the coagulation system is activated in these
patients