Risk factors for thromboembolic events in renal failure

Objectives: To determine whether prior thromboembolic events (TE) influence current measures of hemostasis, inflammation and oxidative stress in a population at high cardiovascular risk. Background: Renal failure patients demonstrate a remarkably elevated incidence of TE. Methods: Relationships between plasma test results and prior TE history were studied in 78 diabetic and 23 non-diabetic patients with renal failure. TE were defined as myocardial infarction, stroke or vascular surgery. Results: Markers for inflammation (interleukin (IL)-6, C reactive protein (CRP)), thrombosis (fibrinogen, low molecular weight (LMW) fibrinogen, factor VII, viscosity), fibrinolysis (fibrinolytic activity, plasminogen activator inhibitor (PAI)), endothelial/platelet activity (P-selectin, von Willebrand factor (vWf)) and oxidative stress (antibody to oxidized low-density lipoprotein (LDL), advanced glycated end products) were significantly different from a healthy control population. Dialysis patients with diabetes were twice as likely to have sustained a TE (58 vs. 30%, p=0.032). Those patients in the total group with levels above the median for IL-6 (p=0.045), and CRP (p<0.017) were more likely to have sustained a TE than those with levels below the median. Those diabetic patients with levels above the median for CRP were more likely to have a prior history of TE (p<0.021). For non-diabetic patients, levels above the median of IL-6 were associated with a prior history of TE (p=0.027). Multiple correlations for factors of inflammation, hemostasis and oxidative stress indicate that these mechanisms are not independent of one another. Conclusion: Prior TE was associated with markers of inflammation a relationship that may influence the interpretation of these tests which are strongly interrelated in patients at high cardiovascular risk.