Plasma Fibrinogen Levels and Protein C Activity in Patients with Chronic Kidney Disease in a Nigerian Tertiary Hospital

Abstract

Introduction: Haemostatic abnormalities have been observed in patients with chronic kidney disease (CKD). Hypercoagulability and  thrombotic complications may contribute to the increased morbidity and mortality associated with CKD. Thrombotic tendency has not  been fully evaluated in CKD subjects in our environment. This research was to assess the plasma fibrinogen and protein C activity levels in  patients with CKD in a Nigerian tertiary hospital, with the view of deducing their associations with thromboembolic manifestations and providing possible therapeutic interventions.

Material and Methods: A hospital based, cross-sectional survey conducted amongst CKD patients on renal replacement therapy (RRT),  who were managed in the renal unit of the University of Benin Teaching Hospital (UBTH). Participants were appropriately matched with  apparently healthy control subjects and these were interviewed with a structured questionnaire to obtain data on their clinical details as  well as hospital records. Citrated plasma was obtained and analysed to determine the functional protein C activity as well as the  fibrinogen levels of both subjects on RRT and apparently healthy control. Haematologic and biochemical parameters were also  determined including complete blood count, urea and creatinine and liver function tests. Descriptive and Inferential statistics were  performed using Statistical Package for Social Sciences (SPSS) version 20. Results were presented in tables and charts

Results: A total of 222 subjects participated in this study, comprising 74 patients with CKD on conservative management, 74 subjects with  CKD on RRT, and 74 apparently healthy control subjects. The mean age across the groups including subjects on conservative  management, RRT, and controls were 54.70±14.42, 49.5±15.73, and 49.3±12.5 years respectively; with the median age of 56-, 52-, and 48.5- years f across the groups respectively. The mean plasma fibrinogen levels across the groups were 240.4±57.76, 241.8±54.87,  360.9±69.5mg/dl respectively. This was statistically significant. The mean protein C activity for the respective groups was 59.6 ± 24.20, 63.6  ± 28.89, 86.7.±2.6%. Protein C activity was significantly depleted in the CKD subjects (p = 0.002).

Conclusion:  The study showed a low  protein C activity amongst patients with CKD and those with cardiovascular or thromboembolic events, suggestive of  thromboembolic risk in these individuals. Contrary to existing literature, plasma fibrinogen levels were not significantly elevated in  patients with CKD, and there was no association with thromboembolic events.