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Assessment of Vascular Function in Patients With Chronic Kidney Disease
Published on: June 16, 2014
Blood coagulation system in patients with chronic kidney disease: a prospective observational study
Meng-Jie Huang1, Ri-Bao Wei1, Yang Wang1
1Department of Nephrology, Chinese PLA General Hospital, Chinese PLA Institute of Nephrology, State Key Laboratory of Kidney Diseases, National Clinical Research Center for Kidney Diseases, Beijing Key Laboratory of Kidney Disease Research, Beijing, China.
Insights
Patients with chronic kidney disease (CKD) exhibit heightened coagulation, particularly elevated Factor VIII (FVIII) activity. These hemostatic alterations may increase thrombotic event risk, warranting further investigation.
Area of Science:
- Nephrology
- Hematology
- Cardiovascular Medicine
Background:
- Thromboembolic events significantly impact patient prognosis in chronic kidney disease (CKD).
- Haemostatic alterations are implicated in CKD complications, but their precise roles are not fully understood.
- Understanding coagulation mechanisms is crucial for managing thromboembolic risk in CKD patients.
Purpose of the Study:
- To investigate the complete coagulation process in CKD patients.
- To elucidate the mechanisms underlying the high thromboembolic risk in CKD.
- To identify specific haemostatic biomarkers associated with CKD progression.
Main Methods:
- Prospective observational study of 95 CKD patients and 20 healthy controls.
- Comprehensive analysis of coagulation parameters including platelet count, aggregation, von Willebrand factor (vWF:Ag, vWF:RCo), fibrinogen, coagulation factors (FV, FVII, FVIII), inhibitors (antithrombin III, protein C, protein S), D-dimer, and thromboelastography.
- Multivariable linear regression to assess associations between estimated glomerular filtration rate (eGFR) and haemostatic biomarkers.
Main Results:
- CKD patients showed significantly higher levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII, and D-dimer compared to controls, with elevations correlating with CKD progression.
- Platelet aggregation and thromboelastography parameters did not differ significantly between groups after adjustments.
- vWF:Ag, vWF:RCo, and FVIII were inversely associated with eGFR (p<0.001).
Conclusions:
- CKD is associated with endothelial dysfunction and increased coagulation, notably elevated FVIII activity.
- Abnormal haemostatic profiles, particularly increased procoagulant factors, likely contribute to the elevated thrombotic risk in CKD.
- Further long-term studies with larger cohorts are needed to precisely define the relationship between elevated procoagulant factors and clinical outcomes.
Objectives:
Thromboembolic events are the major factor affecting the prognosis of patients with chronic kidney disease (CKD). Haemostatic alterations are possible causes of these complications, but their roles remain poorly characterised. In the prospective observational study, we investigated the entire coagulation process in patients with CKD to elucidate the mechanisms of their high thromboembolic risk.
Methods:
A total of 95 patients with CKD and 20 healthy controls who met the inclusion criteria were consecutively recruited from September 2015 to March 2016. The platelet count, platelet aggregation, von Willebrand factor antigen (vWF:Ag), vWF ristocetin cofactor activity (vWF:RCo), fibrinogen, factor V (FV), FVII, FVIII, antithrombin III, protein C, protein S, D-dimer, standard coagulation tests and thromboelastography were measured in patients with CKD and controls. Associations between the estimated glomerular filtration rate (eGFR) and haemostatic biomarkers were tested using multivariable linear regression.
Results:
The adjusted and unadjusted levels of vWF:Ag, vWF:RCo, fibrinogen, FVII, FVIII and D-dimer were significantly higher in patients with CKD than that in the healthy controls, and were elevated with CKD progression. However, after adjustment for baseline differences, platelet aggregation and thromboelastography parameters showed no significant differences between patients with CKD and healthy controls. In the correlation analysis, vWF:Ag, vWF:RCo and FVIII were inversely associated with eGFR (r=-0.359, p<0.001; r=-0.391, p<0.001; r=-0.327, p<0.001, respectively). During the 1-year of follow-up, one cardiovascular event occurred in patients with CKD 5 stage, whereas no thromboembolic event occurred in the CKD 3 and 4 and control groups.
Conclusions:
Patients with CKD are characterised by endothelial dysfunction and increased coagulation, especially FVIII activity. The abnormal haemostatic profiles may contribute to the elevated risk of thrombotic events but further longer-term study with large samples is still required to more precisely determine the relationship between the elevation of procoagulant factors and clinical outcomes.
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