Plasma fibrinogen and dialysis
Article Outline
To the Editor:
In a recently published meta-analysis, Goldwasser et al concluded that plasma fibrinogen level is markedly greater in peritoneal dialysis than hemodialysis patients.1 Unfortunately, the investigators had to deal with reports not entirely suitable for meta-analysis. In order to minimize confounding factors such as the time of publication or diabetes mellitus (DM), they needed to stratify the studies into 2 major sets and then the second set into 2 more subsets including patients with or without DM. The final sub-meta-analysis was performed on only 4 studies with 82 peritoneal dialysis and 96 hemodialysis patients, all without DM. Other relevant confounding factors such as age, infections, cause of end-stage renal disease, and therapies could not be analyzed. To test the investigators’ hypothesis, we also analyzed plasma fibrinogen levels in all patients from our dialysis unit. No difference was found between peritoneal dialysis and hemodialysis patients with or without DM (Table 1).
Table 1. Plasma Fibrinogen Levels in Our Population of 67 Dialyzed Patients
| Plasma Fibrinogen, mg/dL | |||
|---|---|---|---|
| n | Mean ± SD | Range | |
| PD all | 13 | 471 ± 105 | 326–626 |
| PD with DM | 2 | 390–494 | |
| PD without DM | 11 | 476 ± 112 | 326–626 |
| HD all⁎ | 54 | 461 ± 146 | 215–817 |
| HD with DM | 15 | 483 ± 121 | 307–737 |
| HD without DM† | 39 | 452 ± 292 | 215–817 |
⁎ P = not significant v PD all. |
† P = not significant v HD with DM and v PD without DM. |
An increasing number of meta-analyses, often carrying arguable messages, are being published. It is also difficult to avoid biases at the time of the statistical analysis resulting from the lack of randomization, assay methods, and so on, of the original reports. A relevant step forward in the field of meta-analysis could be to open a discussion to set rules for reports that eventually can be meta-analyzed.
ALL LETTERS TO THE EDITOR MUST BE SUBMITTED ONLINE VIA EDITORIAL MANAGER (http://ajkd.edmgr.com). Letters should be in response to an AJKD article, and that article should have appeared no more than 6 months previously. The title must be different from that of the original article. Letters must not exceed 250 words (excluding references, maximum number 10) and contain no more than 1 figure or table. Letters are subject to editing and abridgment without notice and there is no guarantee that your letter will be published. Submitting the letter constitutes your permission for its publication in any current or subsequent issue or edition of AJKD, in any form or media, now known or hereafter developed.
Reference
Originally published online as doi:10.1053/j.ajkd.2004.12.025 on February 23, 2005.
PII: S0272-6386(05)00134-4
doi:10.1053/j.ajkd.2004.12.025
© 2005 National Kidney Foundation, Inc. Published by Elsevier Inc All rights reserved.
Refers to article:
- Effect of dialysis modality on plasma fibrinogen concentration: A meta-analysis
