Cortés-López LA, González-Castillo DE, Elizalde-Barrera CI, Flores-Alcántar G

Language: Spanish
References: 12
Page: 581-586
PDF size: 542.58 Kb.

ABSTRACT

Background: Peritonitis is a major complication of patients with chronic kidney disease on renal function replacement by peritoneal dialysis. In Mexico, prevalence of peritonitis in patients on dialysis is 5%. Fibrinogen (clotting factor I) is a soluble plasma protein synthesized in the liver, a precursor of fibrin. It is one of the acute phase reactants, elevated levels in plasma have associated with an increased cardiovascular risk.
Objective: To quantify the levels of plasma fibrinogen and determine if this increase is associated with peritonitis in patients with chronic kidney disease who are on replacement therapy in renal function by peritoneal dialysis.
Material and method: An analytical, observational and crosssectional study was done with the hypothesis: Increase of fibrinogen in patients with chronic renal failure stage 5 K/ DOQI in peritoneal dialysis elevates the risk of peritonitis. We determined a sample of 33 patients with end-stage chronic renal in peritoneal dialysis. Once they accepted to participate in the study cytological samples were collected from peritoneal fluid, as well as clotting time, fibrinogen, hemoglobin, hematocrit, corpuscular volume, electrolytes, and albumin. Patients were divided into two groups: the first without peritonitis and the second with peritonitis. We performed a statistical analysis with descriptive statistics, percentages and averages. Variables were analyzed with c² and t test. Spearman's rho correlation and ROC curve were determined.
Results: Of the 33 patients, 16 were men and 17 were women. The mean age was 43.5 years. The mean serum fibrinogen was generally 599 ± 299.98 mg/dL (with a range of 95 and 998 mg/dL). Group 1 (patients without peritonitis) consisted of 16 subjects, while group 2 (patients with peritonitis) had 17 individuals. Of the latter group (patients with peritonitis) 17 cases (100%) had fibrinogen above the cutoff, while in group 1 only 6 patients (38%) had high fibrinogen. It was established that from the level of serum fibrinogen 577 mg/ dL there is a sensitivity of 94.1% and specificity of 75% for diagnosing peritonitis with a value of p = 0.0001. The risk of peritonitis was 4.6 (95% CI 1.6-13.2), p = 0.0001. It was determined Spearman correlation of 0.71, with a significant p = 0.001.
Conclusion: The elevation of fibrinogen is associated with increased risk of peritonitis in K/DOQI stage V kidney patients who receive replacement therapy for peritoneal dialysis.

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