Prothrombotic changes in platelet, endothelial and coagulation function following hemodialysis

Area of Science:

• Nephrology
• Hematology
• Cardiovascular Medicine

Background:

• Patients undergoing hemodialysis (HD) face a heightened risk of thrombotic events, such as myocardial infarction and vascular access thrombosis.
• Dialysis procedures can potentially trigger prothrombotic changes in the vascular system.

Purpose of the Study:

• To investigate the impact of a single hemodialysis session on key prothrombotic vascular biomarkers.
• To assess changes in platelet, endothelial, and coagulation activation markers before and after hemodialysis.

Main Methods:

• Blood samples were collected from 55 HD patients immediately before and after a dialysis session.
• Platelet function was evaluated using flow cytometry and aggregometry (Ultegra RPFA with TRAP and AA agonists).
• Biomarkers including soluble P-selectin, soluble CD40L, thrombin-antithrombin III (TAT), D-dimer, von Willebrand factor (vWF), and hsCRP were measured.

Main Results:

• Hemodialysis significantly increased platelet activation markers (P-selectin, soluble P-selectin, soluble CD40L) and stimulated fibrinogen binding.
• Coagulation markers (TAT, D-dimer) and endothelial markers (vWF, hsCRP) were significantly elevated post-hemodialysis.
• While some platelet aggregations were reduced, overall markers indicated increased platelet, endothelial, and coagulation activation.

Conclusions:

• A single hemodialysis session induces significant prothrombotic activation of platelets, endothelium, and coagulation, even with heparin use.
• The findings highlight the need for improved medical strategies to counteract the prothrombotic state in hemodialysis patients.