Comparison of hemostatic factors and serum malondialdehyde as predictive factors for cardiovascular disease in hemodialysis patients

Hemodialysis(HD) patients have accelerated cardiovascular morbidity and mor tality rates compared with the general population. Identifying the factors that predict major coronary events in this population can direct the focus on prevention. This cross-sectional study compares known and suspected card iovascular risk factors in HD patients with and without prevalent cardiovas cular disease (CVD). In 76 HD patients (prevalent CVD, 44 of 76 patients), serum lipid, lipoprotein, apolipoprotein (Apo), plasma fibrinogen, tissue p lasminogen activator (TPA), plasminogen activator inhibitor (PAI-1), and fa ctor VII levels were measured using standard kits. Serum malondialdehyde (M DA; a marker of oxidative stress) was measured using spectrophotometry. Pre dictor variables were compared using analysis of variance and chi-squared t ests, as appropriate. CVD prevalence was modeled using multiple logistic re gression analysis, and odds ratios (OR) were calculated. Serum lipid, lipop rotein, Ape, plasma TPA, PAI-1, and factor VII values did not differ signif icantly from laboratory norms or discriminate for prevalent CVD in HD patie nts. Plasma fibrinogen levels were significantly elevated in HD patients co mpared with laboratory norms (369.4 +/- 130.02 v 276.7 +/- 77.7 mg/dL; P < 0.0001) but were not significantly different in HD patients with and withou t prevalent CVD. Serum MDA levels, both before and after the midweek HD tre atment, were significantly elevated in all HD patients compared with labora tory norms (pretreatment, 2.6 +/- 0.8 nmol/mL; posttreatment, 2.1 +/- 0.3 v 0.91 +/- 0.09 nmol/mL; P < 0.01) and were significantly elevated in HD pat ients with prevalent CVD versus those without (pretreatment, 2.8 +/- 0.6 v2 .4 +/- 0.4 nmol/mL; P < 0.01; posttreatment, 2.3 +/- 0.4 v1.94 +/- 0.2 nmol /mL; P < 0.01). Only serum MDA levels, both before and after the midweek tr eatment, contributed to the explanation of variation in CVD prevalence. OR for CVD in the highest versus lowest tertile of pretreatment MDA level was 2.71 (95% confidence interval [Cl] 1.42 to 5.19). ORs for CVD in the highes t versus lowest tertile of posttreatment MDA level was 3.65 (95% CI, 1.6 to 8.32). (C) 1999 by the National Kidney Foundation, Inc.