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Assessment of Vascular Function in Patients With Chronic Kidney Disease
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Assessment of Vascular Function in Patients With Chronic Kidney Disease

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Global coagulation assays in patients with chronic kidney disease and their role in predicting thrombotic risk

Hui Yin Lim1, Brandon Lui2, Mark Tacey3

  • 1Northern Clinical Pathology, Thrombosis & Radiology (NECTAR) Research Group, Northern Pathology Victoria, Northern Health, Epping, VIC, Australia; Department of Medicine, University of Melbourne, Northern Health, Epping, VIC, Australia; Department of Medicine, University of Melbourne, Austin Health, Heidelberg, VIC, Australia; Australian Centre for Blood Diseases, Monash University, Melbourne, VIC, Australia.

Thrombosis Research
|May 7, 2023
PubMed

Insights

Patients with chronic kidney disease (CKD) exhibit a hypercoagulable state, increasing thrombotic risk. Global coagulation assays identified key predictors like tissue factor pathway inhibitor (TFPI) for better risk assessment in CKD patients.

Area of Science:

  • Nephrology
  • Hematology
  • Cardiovascular Medicine

Background:

  • Cardiovascular diseases and thrombosis are leading causes of mortality in chronic kidney disease (CKD) patients.
  • Currently, effective biomarkers for predicting thrombotic risk in CKD are lacking.

Purpose of the Study:

  • To evaluate global coagulation assays in CKD patients.
  • To correlate coagulation biomarkers with clinical outcomes in CKD.

Main Methods:

  • Prospective observational study of 90 CKD patients (eGFR<30 mL/min/1.73m²).
  • Global coagulation assays performed: thromboelastography, calibrated automated thrombogram (CAT), overall hemostatic potential (OHP), and tissue factor pathway inhibitor (TFPI).

Main Results:

  • CKD patients showed hypercoagulable states compared to controls (increased thromboelastography amplitude, peak thrombin, OHP, and TFPI).
  • Peritoneal-dialysis patients exhibited more hypercoagulable parameters than hemodialysis patients.
  • Key predictors of thrombotic complications included dialysis, higher fibrinogen, reduced endogenous thrombin potential, elevated D-dimer, and increased TFPI.

Conclusions:

  • CKD confers a hypercoagulable state, increasing thrombotic risk.
  • Paradoxical association of reduced thrombin generation and raised TFPI with thrombotic risk suggests complex compensatory mechanisms.
  • Developed risk model outperformed existing scores for predicting clinical outcomes in dialysis patients.
Abstract

Keywords:
Cardiovascular diseasesChronic renal insufficiencyFibrinolysisHemostasisThrombin

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