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Chronic Kidney Disease and Its Impact on a Prothrombotic State in Patients with Atrial Fibrillation

Paweł T Matusik1,2, Zbigniew Heleniak3, Elżbieta Papuga-Szela4

  • 1Jagiellonian University Medical College, Faculty of Medicine, Institute of Cardiology, 80 Prądnicka Street, 31-202 Kraków, Poland.

Journal of Clinical Medicine
|August 6, 2020
PubMed

Insights

Advanced chronic kidney disease (CKD) significantly increases clotting and slows clot breakdown in atrial fibrillation (AF) patients. Early-stage CKD did not show these prothrombotic changes.

Area of Science:

  • Cardiology
  • Nephrology
  • Thrombosis Research

Background:

  • Atrial fibrillation (AF) patients face increased thromboembolism risk.
  • The impact of chronic kidney disease (CKD) on thromboembolism in AF is not fully understood.
  • Assessing hemostatic alterations in AF patients with varying CKD stages is crucial.

Purpose of the Study:

  • To investigate the relationship between CKD stages and prothrombotic/antifibrinolytic changes in non-anticoagulated AF patients.
  • To determine if CKD independently predicts altered clot properties beyond established risk factors like CHA2DS2-VASc score.

Main Methods:

  • Retrospective cross-sectional analysis of 502 non-anticoagulated AF patients with eGFR ≥ 15 mL/min/1.73 m².
  • Measurement of hemostatic parameters including endogenous thrombin potential (ETP), clot permeability (Ks), and clot lysis time (CLT).
  • Statistical analysis adjusted for CHA2DS2-VASc score to evaluate the independent effect of CKD stage.

Main Results:

  • Stage 4 CKD patients exhibited higher ETP and prolonged CLT compared to Stage 3 CKD.
  • Stage 4 CKD, but not Stage 3 CKD, independently predicted high ETP and prolonged CLT in the overall cohort.
  • N-terminal pro-B-type natriuretic peptide predicted low Ks and prolonged CLT in patients with Stages 3-4 CKD.

Conclusions:

  • Stage 4 CKD is associated with significant prothrombotic and antifibrinolytic alterations in AF patients.
  • These hemostatic changes in advanced CKD appear independent of clinical stroke risk factors.
  • Early-stage CKD (Stage 3) did not demonstrate similar prothrombotic or antifibrinolytic profiles.

Keywords:
atrial fibrillationchronic kidney diseaseclot propertiesfibrinolysisinflammationprothrombotic statethrombin potential

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