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Coagulation profile in patients with chronic kidney disease before and after kidney transplantation: A retrospective
Jinbeom Cho1, Kang Woong Jun1, Mi Hyeong Kim1
1Department of Surgery, College of Medicine, The Catholic University of Korea, Seoul, Korea.
Insights
Chronic kidney disease (CKD) patients often have clotting issues. Kidney transplantation (KT) significantly corrects these thrombotic factors, improving patient outcomes and renal function.
Area of Science:
- Nephrology
- Hematology
- Transplantation Medicine
Background:
- Patients with chronic kidney disease (CKD) face significant risks of both thrombotic and hemorrhagic complications.
- The precise pathophysiology underlying these hemostatic derangements in CKD remains incompletely understood.
Purpose of the Study:
- To elucidate the mechanisms and characteristics of hemostatic problems in CKD patients.
- To evaluate the efficacy of kidney transplantation (KT) in resolving these abnormalities.
Main Methods:
- Retrospective observational study including 557 kidney transplant recipients.
- Exclusion criteria included perioperative plasmapheresis and graft failure within one month post-KT.
Main Results:
- Elevated homocysteine and D-dimer levels were observed in KT recipients.
- Pre-transplantation, 80.9% of patients had at least one thrombophilic factor, decreasing to 47% by post-operative day 28 (P<.001).
- Better renal function was noted in patients without thrombophilic factors, and pre-operative dialysis duration correlated with thrombotic tendency.
Conclusions:
- CKD patients exhibit hypercoagulability, potentially linked to reduced renal function.
- Hemodialysis (HD) and peritoneal dialysis (PD) can exacerbate prothrombotic tendencies through distinct pathways.
- Kidney transplantation effectively corrects most thrombophilic factors in CKD patients.
Background:
Patients with chronic kidney disease (CKD) tend to experience both thrombotic and hemorrhagic complications; however, the pathophysiology remains unclear. This study aimed to identify the underlying mechanisms and characteristics of hemostatic problems in patients with CKD and to demonstrate the role of kidney transplantation (KT) in correcting these hemostatic abnormalities.
Methods:
In this retrospective observational study, 557 KT recipients who did not receive perioperative plasmapheresis and who did not exhibit graft failure within 1 month after KT were included.
Results:
KT recipients demonstrated increased levels of homocysteine and D-dimer. A total of 80.9% of patients exhibited ≥1 thrombophilic factor at pre-transplantation, and the proportion of these patients decreased to 47% at 28th post-operative day (P<.001). The renal function of patients with no thrombophilic factors was better than that of patients with ≥1 thrombophilic factor at all post-operative assessments (P<.001). The duration of pre-operative dialysis significantly correlated with the thrombotic tendency of patients with CKD before and after KT.
Conclusion:
Patients with CKD can exhibit hypercoagulability, which might be caused by reduced renal function per se. Both HD and PD can aggravate the prothrombotic tendency of patients with CKD via different mechanisms. Most thrombophilic factors in patients with CKD were corrected after KT.
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