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Updated: Jun 21, 2025
A Murine Model of Hemodialysis Access-Related Hand Dysfunction
Published on: May 31, 2022
Hemodialysis patients have signs of a chronic thrombotic burden
Bernd G Stegmayr1, Lennart D Lundberg2
1Department of Public Health and Clinical Medicine, Umea University, Umea, Sweden. bernd.stegmayr@umu.se.
Insights
Fibrin degradation products (D-dimer) were elevated in most hemodialysis sessions, correlating with interdialytic weight gain and fluid removal rates. This suggests a link between D-dimer levels and hemodialysis parameters, potentially impacting patient outcomes.
Area of Science:
- Nephrology and Cardiovascular Medicine
- Hematology and Thrombosis Research
Background:
- Cardiovascular diseases are a primary cause of morbidity in hemodialysis (HD) patients.
- Adequate anticoagulation during HD is crucial to prevent clotting.
- Fibrin degradation products, such as D-dimer, are markers of coagulation activation.
Purpose of the Study:
- To investigate elevated D-dimer levels in hemodialysis patients.
- To determine if D-dimer levels change before and during HD sessions.
- To explore the relationship between D-dimer levels and hemodialysis-related parameters.
Main Methods:
- Observational study of 20 hemodialysis patients undergoing 60 low-flux dialysis sessions.
- Blood samples collected predialysis, and at 30 and 180 minutes during HD.
- Analysis of D-dimer levels, interdialytic weight gain (IDWG), and fluid removal rate (UF-rate).
Main Results:
- 95% of sessions showed elevated predialysis D-dimer levels.
- D-dimer levels decreased at 30 minutes and returned to predialysis levels at 180 minutes.
- Predialysis D-dimer levels correlated significantly with IDWG and UF-rate.
Conclusions:
- Elevated D-dimer levels are common in hemodialysis patients, both before and during treatment.
- D-dimer levels are significantly associated with interdialytic weight gain and fluid removal rates.
- Further research is needed to explore if optimizing these parameters can reduce subclinical thromboembolic events and improve patient outcomes.
Background:
Cardiovascular diseases are the dominant cause of morbidity in hemodialysis (HD) patients. Unless sufficient anticoagulation is used during HD, clotting may appear. The objective was to investigate if levels of fibrin degradation products (D-dimer) were increased before and during HD.
Methods:
The combined observational study included 20 patients performing a total of 60 hemodialysis divided into three sessions of low-flux dialysis. None of the patients suffered from any clinically evident thromboembolic event before or during the study. Median bolus anticoagulation (mainly tinzaparin) doses were 84 Units/kg bow. Blood samples were drawn before HD (predialysis), and at 30min and 180min during HD with focus on analyzing D-dimer levels and its relation to interdialytic weight gain (IDWG) and speed of fluid elimination by HD (UF-rate).
Results:
Predialysis, D-dimer levels (mean 0.767 ±0.821, min 0.136mg/L) were above the upper reference value in 95% of the sessions. D-dimer levels were lowered at 30min (p<0.001) and returned to predialysis levels at 180min. Predialysis D-dimer correlated with NT-pro-BNP, Troponin T, IDWG and UF-rate. Multiple regression analysis revealed that the D-dimer levels were significantly related to IDWG and the UF-rate.
Conclusions:
D-dimer levels were elevated in a high proportion predialysis and during HD and related to the IDWG and the UF-rate. Awareness of D-dimer levels and future studies will help clarify if optimization of those variables, besides anticoagulation and biocompatibility measures, will eradicate the repeated subclinical thromboembolic events related to each HD; one reason that may explain organ damage and shortened life span of these patients.
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