Effect of dialysis modality on plasma fibrinogen concentration: A meta-analysis

Background: Concentrations of plasma fibrinogen, a vascular risk factor, tend to be greater in patients on peritoneal dialysis (PD) than hemodialysis (HD) therapy, like concentrations of serum cholesterol, lipoprotein(a), and transthyretin, despite the substantial loss of protein during PD. Worse vascular outcome has been noted in PD patients compared with HD patients in several studies. Methods: In this study, the mean difference in plasma fibrinogen levels (PD − HD) was quantified by means of meta-analysis of mean differences found in 12 cohorts with both PD and HD patients (set 1; N = 630) by using a fixed-effects model and meta-analysis of mean fibrinogen values reported in 30 cohorts of patients on a single dialysis modality (set 2; 8 PD cohorts, 22 HD cohorts; N = 2,096) by using a mixed model. Results: On meta-analysis, the weighted mean difference (PD − HD) was 105 mg/dL (95% confidence interval [CI], 86 to 124 [3.1 μmol/L; 95% CI, 2.5 to 3.6]) in set 1 and 103 mg/dL (95% CI, 53 to 153 [3.0 μmol/L; 95% CI, 1.6 to 4.5) in set 2. Conclusion: Like other vascular risk factors, such as cholesterol and lipoprotein(a), plasma fibrinogen level is markedly greater in PD than HD patients, with an approximate difference of 100 mg/dL [2.9 μmol/L]. Different plasma reference ranges for fibrinogen need to be defined for PD and HD patients. The mechanism for the difference and the possible role of hyperfibrinogenemia in worsening vascular disease in PD patients deserve study.

Index words:  Fibrinogen , peritoneal dialysis (PD) , hemodialysis (HD) , meta-analysis , albumin , reference interval