Serum fibrinogen predicts diabetic ESRD in patients with type 2 diabetes mellitus

Although increased serum fibrinogen level was often observed in patients with diabetic nephropathy (DN), its association with DN severity and progression remains unclear. The aim of this study was to investigate the relationship between the serum fibrinogen levels and clinicopathological features and renal prognosis in Chinese patients with type 2 diabetes mellitus (T2DM) and DN.

A total of 174 patients with T2DM and biopsy-proven DN were enrolled. Patients were stratified by the quartiles of serum fibrinogen levels; Q1: <3.30 g/L; Q2: between 3.30 and 4.00 g/L; Q3: between 4.00 and 4.74 g/L; Q4:≥4.74 g/L. The renal outcomes were defined by reaching end stage renal disease (ESRD). The influence of serum fibrinogen levels on renal outcomes was evaluated using Cox regression analysis.

The factors associated with higher level of fibrinogen (Q3 and Q4) were diabetic retinopathy, low e-GFR, high proteinuria and severe glomerular and tubulointerstitial lesions. Importantly, in adjusted analysis, higher levels of fibrinogen were independently related with a greater risk of reaching ESRD with a hazard ratio (HR) of 1.64 per standard deviation (SD) of the natural log-transformed fibrinogen concentration (95%CI, 1.22-2.20; p = 0.001). In reference to the Q1, the risk of renal failure increased by quartiles of the serum fibrinogen level: the HRs were 7.12 for the Q2 (95%CI, 2.29-22.16; p = 0.001), 5.77 for Q3 (95%CI, 1.99-16.75; p = 0.001), and 8.81 for Q4 (95%CI, 2.79-27.80; p < 0.001).

These findings suggested that the elevated serum levels of fibrinogen were associated with diabetic ESRD in patients with T2DM.