Comprehensive Evaluation of Coagulation and Anticoagulation Markers in Chronic Kidney Disease: Diagnostic and Prognostic Insights
DOI:
https://doi.org/10.35516/jmj.v60i2.3860Keywords:
Chronic Kidney Disease (CKD), Coagulation Markers, Anticoagulation Markers, D-dimer, Fibrinogen, Protein C, Glomerular Filtration Rate (GFR)Abstract
Background: In Chronic Kidney Disease (CKD), both the markers of coagulation and anticoagulation, which are predictors of the disease process and its complications, were profoundly disturbed. This study will discuss further the correlations of both markers with renal function, identify the predictors of Glomerular Filtration Rate (GFR), and make use of higher-order statistical analyses in exploring diagnostic and prognostic value.
Methods: The current study measured the markers of coagulation and anticoagulation D-dimer, fibrinogen, Protein C, and Protein S among 100 CKD patients, along with renal function parameters such as GFR and serum creatinine. Other statistical procedures used were correlation, multivariate regression, cluster analysis, receiver operating characteristic analysis, interaction analysis, Kaplan-Meier survival, and machine learning algorithms. Path analyses were used to estimate direct and indirect effects of markers on GFR.
Results:
- Elevated D-dimer (0.69 ± 0.29 mg/mL) and fibrinogen (372.04 ± 80.39 mg/dL) levels were associated with reduced GFR, while higher Protein C (67.90 ± 22.56%) and Protein S (64.93 ± 24.08%) levels correlated with better kidney function.
- Multivariate regression identified hemoglobin (β = 1.20), Protein C (β = 0.80), and Protein S (β = 0.75) as positive predictors of GFR, whereas D-dimer (β = -5.50) and fibrinogen (β = -3.50) were negative predictors (P < 0.001).
- Cluster analysis revealed three distinct groups based on GFR and coagulation profiles, with severe CKD associated with elevated D-dimer and fibrinogen and reduced Protein C and Protein S.
- ROC analysis showed D-dimer to be the most accurate marker for predicting reduced GFR (<60 mL/min; AUC = 0.91, sensitivity = 90%, specificity = 85%).
- Kaplan-Meier survival analysis demonstrated shorter survival times in patients with elevated D-dimer and fibrinogen levels (P < 0.001).
- Path analysis highlighted the complex interplay of coagulation markers on GFR, with D-dimer and fibrinogen exerting negative effects and Protein C and Protein S showing positive influences.
Conclusions: Coagulation and anticoagulation markers may be of critical importance in the very process of CKD, carrying loads of diagnostic and prognostic importance. Advanced statistical and machine learning methods provide a profound understanding of these relations and form the basis for personalized CKD management strategies.
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