Journal Article

Evaluation of hemostasis in patients with end-stage renal disease

Saner, Fuat H., Benkö, Tamas, Lisman, Ton, Witzke, Oliver, Rohn, Hana, Gäckler, Anja, Kribben, Andreas

2019

Overview

An increased bleeding risk is reported for patients with end-stage renal disease. This study aims to analyze, whether bleeding risk can be assessed by global tests of hemostasis. Standard laboratory tests and an extended evaluation of hemostasis by rotational thromboelastometry, platelet function analyzer (PFA) and multiple electrode aggregometry as well as thrombin generation assays and measurement of fibrinolytic potential were performed in 20 patients on hemodialysis, 10 patients on peritoneal dialysis, 10 patients with chronic kidney disease stage G5 (CKD5) and in 10 healthy controls (HC). Hemoglobin was significantly lower in patients with end-stage renal disease versus HC (each p<0.01). Patients on peritoneal dialysis showed increased fibrinogen levels compared to HC (p<0.01), which were also reflected by FIBTEM results (each p<0.05). 41% of hemodialysis patients and 44% of CKD5 patients presented with prolonged PFA-ADP-test (p<0.05), while no patient on peritoneal dialysis and no HC offered this modification. Thrombin generating potential was significantly lower in patients on hemodialysis, while clot lysis time revealed a hypofibrinolytic state in patients on hemo- and peritoneal dialysis compared to HC (p<0.001). In conclusion, patients with end-stage renal disease have complex hemostatic changes with both hyper- and hypocoagulable features, which are dependent on use and type of dialysis. Hypercoagulable features include elevated fibrinogen levels and a hypofibrinolytic state, whereas hypocoagulable features include decreased thrombin generating capacity and platelet dysfunction. Our results may contribute to a more rational approach to hemostatic management in these patients.

• Publisher: Public Library of Science,Public Library of Science (PLoS)
• Subject: Adenosine diphosphate / Biology and Life Sciences / Bleeding / Blood platelets / Care and treatment / Chronic kidney failure / Clinical medicine / Complications and side effects / Dialysis / Disease control / Electric power generation / Electrodes / Embolisms / End-stage renal disease / Evaluation / Female / Fibrin / Fibrinogen / Generating capacity / Glycosylated hemoglobin / Health risks / Heart attacks / Hemodialysis / Hemoglobin / Hemoglobins / Hemorrhage / Hemostasis / Hemostatics / Hospitals / Humans / Infectious diseases / Kidney diseases / Kidney Failure, Chronic - blood / Kidney Failure, Chronic - therapy / Laboratories / Laboratory tests / Lysis / Male / Medical research / Medicine and Health Sciences / Middle Aged / Mortality / Nephrology / Patients / Peritoneal Dialysis / Peritoneum / Phlebotomy / Platelet Function Tests / Platelets / Risk analysis / Risk factors / Surgery / Thrombelastography / Thrombin / Thrombosis / Tranexamic acid / Transplants & implants