C-Reactive Protein and D-Dimer Levels among Patients with End-Stage Renal Disease on Maintenance Hemodialysis: A Cross-Sectional Study

Abstract

End-stage renal disease patients on maintenance hemodialysis exhibit a persistent pro-inflammatory and pro-thrombotic state that significantly increases cardiovascular morbidity and mortality. This study aimed to determine the prevalence of elevated CRP and D-dimer in hemodialysis patients in Zawia, Libya, and examine their associations with age, sex, dialysis vintage, and major comorbidities. A cross-sectional study was conducted at Zawia Kidney Hospital between March and May 2026, enrolling 91 adult maintenance hemodialysis patients. Pre-dialysis venous blood samples were collected and analyzed for serum CRP and plasma D-dimer. Kruskal-Wallis and Mann-Whitney U tests, Pearson and Spearman correlations, and chi-square tests were applied, with significance set at p < 0.05. Elevated D-dimer (>0.5 mg/L) was detected in 79.1% of patients, while elevated CRP (>10 mg/L) was present in only 11.0%. Neither biomarker correlated significantly with dialysis vintage. D-dimer levels varied significantly across age groups (p = 0.041), with the 30–45-year group recording the highest values (mean 5.61 mg/L) — exceeding even older age groups. Cardiac disease was the only comorbidity independently associated with D-dimer elevation (OR = 3.23; p = 0.047). D-dimer elevation is near-universal among hemodialysis patients, while CRP elevation remains infrequent. Younger patients exhibited disproportionately elevated D-dimer levels, suggesting more aggressive underlying disease. Cardiac comorbidity was the principal driver of coagulation activation. Age-stratified analysis and cardiac risk assessment are essential when interpreting coagulation biomarkers in this population.